CARE HOMES FOR OLDER PEOPLE
Anzac House London Road Devizes Wiltshire SN10 2DY Lead Inspector
Roy Gregory Key Unannounced Inspection 09:10 19 & 20 September 2007
th 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.V340889.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 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 www.osjct.co.uk The Orders Of St John Care Trust Winifred Patricia Lavery 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.V340889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No more than 30 service users with dementia may be accommodated at any one time. One named service user in the category of mental disorder, excluding learning disability or dementia over the age of 65 years. 15th August 2006 Date of last inspection Brief Description of the Service: Anzac House 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 dates from the 1970s. It is run by the Orders of St John Care Trust, which has a number of homes for older people in Wiltshire and in three other counties. The accommodation is on two floors connected by passenger lift and a staircase. The home is divided into smaller units, each with its own sitting room, dining room and small kitchen. There is also a main dining room and adjacent sitting room, so people have a choice of where to go in the home. All meals are prepared in a central kitchen. All the bedrooms are single rooms, with wash hand basins. They have shared toilets and bathrooms nearby. The home has two beds for respite care made available to people with dementia in the local community. The home is situated in its own grounds on the Eastern edge of Devizes. It has its own car park, and there are good bus links to other towns. People considering using Anzac House receive an information brochure. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced visit for this inspection was made on Wednesday 19th September 2007 from 9:10 a.m. to 5:45 p.m., with a return visit the following day between 9:30 a.m. and 2:30 p.m. The registered manager, Pat Lavery, was available during the inspection visits, as was Jill Mitchener, her locality manager, who was at the home to assist Mrs Lavery with staff interviewing. The inspector also spoke with two care leaders, the day care co-ordinator, the administrator, and members of the care and support staff teams. During the inspection there was direct contact with a number of residents, in the sitting rooms and individual rooms. The service of meals was observed in two of the dining rooms, and organised activities were seen in three locations. The entire home was toured. Prior to the inspection, Pat Lavery had supplied detailed information by way of the Annual Quality Assurance Assessment, as is now required by the Commission for Social Care Inspection. The inspector gave or sent questionnaires to the relatives of six residents, all of which were returned. It was also possible to look at the results of the home’s annual internal survey of residents’ and relatives’ opinions, from July 2007. Other documentation looked at included records in respect of care planning and delivery, risk assessment, training and recruitment. The pharmacist inspector examined practice, storage and records concerning medicines used in the home. A number of instances of care giving were observed. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visits to the home. They take into account the views and experiences of people who live there. What the service does well:
So far as they could engage, residents expressed satisfaction with living at Anzac House. Responses to the survey of relatives were almost universally positive, with comments about a “relaxed atmosphere” and good exchanges of information. A letter on file at the home referred to “a good quality preadmission visit that helped our decision to choose this home”. Care plans that were sampled contained a wide range of information and guidance to staff. They included guidance about how individuals’ dementia presented itself and therefore how they could be kept safe. Care plans crossreferred to risk assessments. All care staff spoken to seemed familiar with care plans and demonstrated constant recording of the work they did. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 6 Care plans were written in a way that drew attention to respect for individuals. For example, a person needed physical assistance to dress, which their care plan described, but it also emphasised the importance of encouraging the person’s ability to choose what to wear. Their plan for social activities noted a number of things they liked to be involved in, but also reminded carers there were times when they preferred their own company. Throughout the inspection there were many examples of excellent care interactions between staff and residents. Staff never seemed too busy to stop and exchange pleasantries at least. People were treated with patience and dignity, and made to feel small requests were important. A person expressed a dislike for the music playing in the main sitting room. A member of staff took time to find something to suit their preference. Records and observations showed different activities took place every day, in all parts of the home. A quiz session that was taking place in a small sitting room was pitched at the abilities, interest and attention span of the participants. Some residents in the main sitting room were encouraged to join in a ball catching game. Records showed that other activities from preceding days had included a daily newspaper reading session, skittles, a small group discussion about the places where they grew up, and some one-to-one sessions. The home had the added advantage of a group of staff who performed musical events for the home on special occasions through the year. A relative responding to the survey wrote, “There are efforts made to find stimulating activities”. Two other respondents made additional comments about the range of social events and entertainment provided. Some residents liked to help with various domestic chores, such as folding laundry, laying tables or dusting. This was encouraged, and was recognised in individual care plans. Some staff had looked at the dining experience for residents. They had found that the main dining room could be very noisy. In response they had decided a policy of closing the servery hatch as soon as the main meal had been served. Staff were careful to work at table level with people who needed assistance with eating. Restful music was played in the background. The result was a homely dining experience, where people could take as long as they liked over their meal. The smaller dining rooms were in any case on a homely scale. Staff presence there was equally person-centred. People had a choice of main course and of sweets. All care staff received dementia training, a “Quality Dementia Care package” accredited by The Alzheimer’s Society, as a part of core training. The activities co-ordinator was about to attend training about life history and reminiscence work. Housekeeping and kitchen staff confirmed they received dementia awareness training. They could not envisage doing their jobs effectively without it. People in different roles spoke of the cohesiveness of the entire staff team, which came across as a particular strength of the home. There was also a high rate of achievement of National Vocational Qualifications. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The Trust had reintroduced “Waterlow” pressure area risk assessments, together with nutrition risk assessments. These were at a “trial” stage, so there were examples of forms having been completed but without numerical scores being totalled. It is important that these new systems become understood and used as a part of everyday care practice as soon as possible, so the home can demonstrate interventions that promote tissue viability and minimise risks of pressure damage occurring. An enhancement to the activity care plans would be to set out the aims being sought. Primarily people will want to do things that interest them and relate to their past experience, but there may be particular aims that activity or occupation could help, such as movement or socialising. Such an approach would lend itself to evaluation by the activities co-ordinator and key workers. There would be value in seeking the guidance and agreement of mental health professionals on behaviour guidelines for individuals. Then in the event of disagreement with anyone about the approach used, or of a referral to safeguarding procedures, the home could demonstrate that decisions had already been reached on an inter-professional basis. Storage for commode buckets was poor. This was due to the poor state of the sluice, which was about to be completely redesigned. However, to minimise the risk of cross-infection, commode buckets should be numbered, so that they are always returned to the same user after being cleaned. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 8 In the questionnaires returned to the inspector, one relative considered the incidence of odour as the one aspect of the home they disliked. This was also an issue for one respondent to the home’s own survey. The home was mainly odour-free during the inspection, and standards of cleaning were high everywhere, but it was noted that at weekends and evenings, there was reduced availability of housekeeping staff. There needs to be further attention to deployment of housekeeping staff in order to cover as much of the week as possible, including weekends. It is also recommended to consider fitting dining areas with alternative floor coverings to reduce the difficulties and time commitment in keeping such areas clean. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Key standard 6 does not apply.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide are kept up to date so that prospective residents and their relatives have good information the service. Each person’s needs are assessed in detail to ensure that their needs can be met. EVIDENCE: The Trust had introduced a new format for gathering information on prospective residents, to ensure assessments are conducted in a consistent way. There had been no recent admissions, so this new system had not yet been used. However, the home has a record of thorough assessment processes and current residents were appropriately placed. For the most recently admitted person, there was a record of full assessment, which had been completed over a week before the person was admitted. A letter from the relative of another person referred to “a good quality pre-admission visit that helped our decision to choose this home”.
Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 11 Respite admissions were made through a centralised booking procedure. Mrs Lavery said referrals for respite were not accepted without the home carrying out its own assessment first. When people were admitted to hospital, there was evidence that senior staff from the home carried out a re-assessment at the hospital to ensure Anzac House could meet their needs before agreeing to re-admit. All prospective residents and their families were provided with a readable guide to the home. The Trust had introduced a standard format for the statement of purpose. This was a professional document that had been adapted to the home’s specific needs. It could be amended in response to changes, as was demonstrated when it was requested that additional information be inserted to show the staffing levels that the home aims to provide. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and health care needs were met through care planning, except for inadequate planning to reduce risk to people vulnerable to pressure damage. People were treated with respect and their right to privacy was upheld. Residents were protected by the home’s procedures for the safe handling of medicines. EVIDENCE: Care plans that were sampled contained a wide range of information and guidance to staff. They included guidance about how individuals’ dementia presented itself and therefore how they could be kept safe. Care plans crossreferred to risk assessments, including manual handling assessments, and falls risk assessments. There was evidence of plentiful liaison with people’s families, with joint working on some aspects of care. For one person, for example, there was a record of discussions with their family. They had an agreement about how staff and family members would give emotional support to the person’s reactions to family visits. In the care office a chart ensured reviews of care plans took place regularly.
Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 13 In handovers between shifts of staff, there was a review of all residents. This included mentioning if people had been engaged in any activity, and whether they had been observed to be drinking or eating more or less than usual. Any new, intended or ongoing liaison with health professionals was discussed, and changes to care plans were made known to staff. All care staff spoken to seemed familiar with care plans and demonstrated constant recording of the work they did. Any concerns were brought to the attention of the care leader, whose role was to direct care and obtain medical attention as necessary. There were examples of GPs and specialist nurses having made entries in the care records. It was possible to track through records, where a concern had been raised, who had been contacted and what the outcome was. In the case of someone with a urinary infection, for example, a carer’s observations led swiftly through a chain of liaison to prescription at the surgery of a course of antibiotics. There were also records of people being supported to attend doctors’ surgeries and clinics. The manager regretted that local mental health agencies were unable to provide their former level of support. The Trust had reintroduced “Waterlow” pressure area risk assessments, together with nutrition risk assessments. These were at a “trial” stage, so there were examples of forms having been completed but without numerical scores being totalled. It is important that these new systems become understood and used as a part of everyday care practice as soon as possible, as the home could not demonstrate a pro-active approach to avoidance of pressure damage. In response to a requirement made at the previous inspection, care plans contained details and guidance about people’s needs in relation to specific conditions, for example diabetes. There was also some guidance, where needed, on management of behaviour issues. Daily notes of care given and of observations were of a good standard. Care plans were written in a way that drew attention to respect for individuals. For example, a person needed physical assistance to dress, which their care plan described, but it also emphasised the importance of encouraging the person’s ability to choose what to wear. Their plan for social activities noted a number of things they liked to be involved in, but also reminded carers there were times when they preferred their own company. Where a person’s night care plan required half-hourly checks as a result of a falls risk assessment, it showed that their agreement had been sought to being checked in their room. Throughout the inspection there were many examples of excellent care interactions between staff and residents. Staff never seemed too busy to stop and exchange pleasantries at least. A carer noted that a lady was not wearing a necklace, which was unusual for them, and arranged to get one so they could maintain their customary appearance. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 14 People were treated with patience and dignity, and made to feel small requests were important. A person expressed a dislike for the music playing in the main sitting room. A member of staff took time to find something to suit their preference. There was a requirement at the previous inspection that female residents or their representatives must be consulted about the delivery of intimate personal care by male staff, and preferences recorded in their care plan. There was evidence in plans that this had been actioned in full. Another requirement concerned making arrangements for residents’ nail care. This had been addressed by incorporating a manicure session into the weekly activities provision. The Pharmacist Inspector looked at arrangements for the handling of medicines, and reports as follows: All appropriate medication records were completed, including specific records for medicines prescribed ‘as required’. Separate protocols in the form of shortterm care plans were completed for all ‘as required’ and variable medication doses. Doctors’ visits and any changes to medication were clearly recorded. Part of a medication round was observed. The staff member was seen to act in accordance with the procedure and dealt with residents sensitively, encouraging them where necessary. Any refusals were recorded and followed up with the doctor. All medication was stored securely and appropriately, although consideration should be given to the window of the room, which is visible to other areas of the home. Controlled drugs records were maintained accurately and administered in accordance with the procedure. Blood monitoring equipment in use in the home did not comply with recent safety guidelines from the Medicines and Healthcare Regulatory Authority. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was active in identifying and meeting people’s social, religious and recreational needs. People kept in contact with family and friends and went out into the community with support. People had a choice of meals, served in a homely way. EVIDENCE: Records and observations showed different activities took place every day, in all parts of the home. A quiz session that was taking place in a small sitting room was pitched at the abilities, interest and attention span of the participants. Some residents in the main sitting room were encouraged to join in a ball catching game. Records showed that other activities from preceding days had included a daily newspaper reading session, skittles, a small group discussion about the places where they grew up, and some one-to-one sessions. From the records, people’s key workers and families could see what their level of participation was and how well they were responding. There were also photographs of various recent activities and trips on display. The home had the added advantage of a group of staff who performed musical events for the home on special occasions through the year.
Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 16 All care staff took part in leading activities as part of their working duties. There was a designated activities co-ordinator, and the day care co-ordinator also had time to devote to more involved activities, as the number of day-care users had fallen. Recently, for example, she had worked with three residents to produce a salt-dough harvest loaf. The activities co-ordinator had the benefit of meeting her opposite numbers from other Trust homes in the locality to share knowledge and experience. Some social events were organised by the Trust to bring residents of different homes together. All respondents to the relatives’ survey considered the home to support people to live the life they would choose “always” or “usually”. One added the home “makes the residents comfortable and relaxed”. Another also complimented the home’s “relaxed atmosphere” and wrote, “There are efforts made to find stimulating activities”. Two other respondents made additional comments about the range of social events and entertainment provided. In the main sitting room there was a board showing the day’s date and outside weather. It also had a reminder of when the daily newspaper would be looked at together. A person said how useful they found this. Music was played extensively around the home, but was not intrusive. Staff members responded to requests to turn volume up or down. Some people had televisions in their bedrooms. Televisions in sitting rooms were not left uniformly on. Some residents liked to help with various domestic chores, such as folding laundry, laying tables or dusting. This was encouraged, and was recognised in individual care plans. An enhancement to the activity care plans would be to set out the aims being sought. Primarily people will want to do things that interest them and relate to their past experience, but there may be particular aims that activity or occupation could help, such as movement or socialising. Such an approach would lend itself to evaluation by the activities co-ordinator and key workers. Near the small servery kitchens there were invitations to visitors to use the drink-making facilities. Visitors were in the home at all times of day, seeing people in individual and shared rooms. The home had a most attractive modern hairdressing salon. The price list for this was displayed at various places in the home. There was also clear information about the availability of Church of England and Roman Catholic services. Staff described support that had been available when required to people of different denominations. Mrs Lavery described how the staff had given attention to residents’ experience of meal times. They had found that the main dining room could be very noisy. In response they had decided a policy of closing the servery hatch as soon as the main meal had been served. Staff were careful to work at table level with people who needed assistance with eating. Restful music was played in the background. The result was a homely dining experience, where people could take as long as they liked over their meal.
Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 17 The smaller dining rooms were in any case on a homely scale. Staff presence there was equally person-centred. People had a choice of main course and of sweets. People were presented with plates of the two choices at the dining table so they could see the meals and make their choice. Residents who needed a special diet were catered for and this was recorded in their care plan. The chef considered herself fully involved in the wider staff team and had seen advantages from the improved way of serving meals. There was good provision of jugs of soft drinks in communal areas. Staff took initiative in promoting their use. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. EVIDENCE: Information about the Trust’s complaints policy and procedure was displayed on notice boards upstairs and down. No complaints had been received since the previous inspection. The Trust has effective monitoring systems in place to oversee how its homes receive and handle complaints. At a recent team meeting, Mrs Lavery had gone over the complaints system with staff, stressing the importance of assisting people to make a complaint if necessary. Care leaders had a responsibility for inviting people to have concerns considered as formal complaints, if they wished. Since the previous inspection, Mrs Lavery has demonstrated competence and co-operation in referring certain matters into local inter-agency safeguarding procedures. One incident was unusual and led to some learning points for staff about preservation of evidence. In that case, a plan had been successfully put in place to keep an individual safe from harm. All staff received abuse awareness training and were issued with the “No Secrets” abbreviated guide to local safeguarding procedures. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 19 Visitors to the home were required to ring the doorbell for entry, and to sign in and out. The front door was controlled by a PIN-coded lock. Individual care plans showed the measures assessed as necessary to help keep people secure, in the light of their dementia. They also contained some guidance, where appropriate, on responses to behaviour patterns that an individual might display to others. There would be value in seeking the guidance and agreement of mental health professionals on behaviour guidelines for individuals. Then in the event of disagreement with anyone about the approach used, or of a referral to safeguarding procedures, the home could demonstrate that decisions had already been reached on an inter-professional basis. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home was homely, safe and well-maintained. There were good standards of hygiene around the home, but these were compromised by dated and inadequate sluice facilities, and by a shortage of housekeeping staff at certain points in the week. EVIDENCE: The home and gardens presented well throughout, apart from the sluice, which had flaking plaster and severe lime-scaling, and was too small for its function. It was confirmed during the inspection, however, that planned works to provide for a new sluice were to commence the following week. The redesigned room would include a macerator and be able to cope with all needs related to commode use in the home. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 21 At the inspection, the laundry was being used for commode bucket storage, although they were being emptied and washed in the sluice. In contravention of a notice over the sink in the laundry, a used catheter bag had been left there. Commode buckets were not numbered, so were being used successively for different people. A previous requirement to replace three toilet and bathroom fire doors had been addressed. Mrs Lavery had identified another toilet as posing risks by virtue of its small size and configuration. The inspector agreed it would be appropriate to redesign that part of the home to overcome the risk currently presented. People said they were happy with their bedrooms, many of which were very personalised. A friendly notice in each room reminded people they were welcome to bring personal items from home, and also described the laundry collection system and use of the call bell. Some bedrooms were less attractive than others, particularly those containing extensive cable or pipe boxing on the walls. Some built-in vanity units appeared dated. The quality survey conducted in-house in July 2007 referred to the lack of a visitor room in the home, which would probably most affect those residents in the smaller bedrooms. There was encouragement to visitors to make use of a conservatory, which had some detachment from the main home, although it was also a shared space for residents’ use. The home was now designated as a non-smoking environment. An outside covered area had been made available for staff to smoke during breaks. A new awning had enhanced resident access to the gardens. Previous inspections have seen that the environment lends itself well to the needs of people with dementia. Consideration could be given to signage for paper towel and liquid soap dispensers in toilets, as their use may not be obvious to those residents who use toilets without staff assistance. One small dining room was out of use for the day, to allow for cleaning the carpet thoroughly. The residents who normally used the room were able to take their lunch in the main dining room. An alternative choice of flooring would remove the need for this regular occurrence, which was also timeconsuming for housekeeping staff. The main dining room had the benefit of an easily cleaned floor. In the questionnaires returned to the inspector, one relative considered the incidence of odour as the one aspect of the home they disliked. This was also an issue for one respondent to the home’s own survey. The home was mainly odour-free during the inspection, and standards of cleaning were high everywhere, including high-risk areas such as behind washing machines. Individual bedrooms received regular special attention under the “resident of the day” scheme. A housekeeper confirmed receipt of infection control training. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 22 However, as at previous inspections, both housekeeping and care staff had concerns about the availability of housekeeper cover throughout the week. In response to a related requirement at the previous inspection, Mrs Lavery had extended housekeeper cover into teatimes. At this time, however, that cover was being redeployed to cover shortage of staff in the mornings. There remained a shortfall of housekeeper staff at weekends, when there was one housekeeper for the home (apart from a kitchen assistant), and that was for mornings only. It as at such times that visitors may be noticing shortfalls in standards. Care staff were having to spend time on laundry and emergency cleaning tasks, taking them away from direct resident contact. A proportion of the resident group had incontinence issues, adding to the pressure of cleaning duties. Mrs Lavery emphasised that laundry was not a priority for care staff at weekends and that night staff rather than day staff could do most of it. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have good support from competent, trained staff who mostly are provided in sufficient numbers. People are protected by sound recruitment practices that ensure nobody works at the home until checks on their background are complete. The provider invests in the development of staff, to maintain a specialist and mainly qualified team. EVIDENCE: The home’s statement of purpose confirmed an aim to provide a minimum of five care staff, including a care leader, during mornings and evenings, and four in the afternoon. It had proved difficult to maintain the levels every weekend, but rotas showed care staffing had never fallen below four. The staffing budget had been increased from April 2007. Recruitment was underway to bring the staff complement up to strength. The home also had the benefit of three relief staff, each of whom knew the home and residents well. It was currently necessary to use one or two agency workers per week, by day and night. Staff spoken to confirmed the agency was able to supply consistent personnel, who could therefore slot easily into any shift required. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 24 The day care and activity co-ordinators’ hours were additional to the care rota. This enabled them to give some of their time to residents in ones and twos, for example to take someone to town or out for a drink. Other care staff ran activities in the sitting rooms but did not have the time to give to individuals, other than as key worker, nor to leave the building. Another provision within staffing hours was “off-rota” time for care leaders. This enabled them to put time to administrative tasks, such as booking-in medications, without the pressure of also running a shift and being involved in direct care tasks. Housekeeping and kitchen staff confirmed they received dementia awareness training. They could not envisage doing their jobs effectively without it. All care staff received dementia training, a “Quality Dementia Care package” accredited by The Alzheimer’s Society, as a part of core training. The activities coordinator was about to attend training about life history and reminiscence work. The Trust had introduced a new centralised system for monitoring when individual members of staff needed to go on refresher courses. The same system allowed the manager to identify when and where courses were available and to book places on them. Of 26 members of care staff, 18 had achieved National Vocational Qualification (NVQ) in care to level 2 or higher, and four were working towards this. The Trust had a commitment to ensuring all care workers achieved at least this recognised baseline standard of qualification. All staff seen presented as committed and knowledgeable about the residents and their needs. Between shifts there were comprehensive handovers of information, to provide continuity of care. Staff maintained a presence all around the home, whilst keeping in regular contact with each other and their supervisors. They spoke of the cohesiveness of the entire staff team, which came across as a particular strength of the home. Recruitment records for three people who had been recruited showed the Trust’s recruitment policies were followed in all cases. People had completed application forms with accompanying declarations about health and freedom from convictions. There were records of interview, and two references were taken up in all cases. Criminal Records Bureau and Protection of Vulnerable Adults checks had been carried out prior to people starting work. Thus people could be sure staff working with them did not present any known risk to their safety. New staff underwent an induction with the Trust, designed to fit with current expectations of induction. This meant new workers had a reliable introduction to the values as well as skills necessary to work in a care home. Staff files now contained photographs as required at the previous inspection, and these were being used on a board in the entrance hall so visitors could identify who was on duty at any time. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their supporters experience an open and competent style of management. The views of people living in the home, and their supporters, are sought and acted on to ensure the home is run in their best interests. People have good quality support because the care workers are regularly supervised. People are safeguarded by the arrangements made for handling their finances. The environment is safe for them and staff because of sound health and safety policies and practices. EVIDENCE: Pat Lavery has been registered as manager since the previous inspection. She has many years experience of working at Anzac House. She has achieved NVQ to level 4 in the past year, and is aiming to gain the Registered Managers Award within the coming year.
Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 26 She is supported actively by Locality Manager Jill Mitchener, who assists interviews for senior staff and supports Mrs Lavery in all safeguarding matters. Mrs Mitchener also provides Pat Lavery with individual supervision, and arranges meetings of all managers in the locality. Pat Lavery and Jill Mitchener were due to attend a dementia training event together in Leicester. Within the home, Pat Lavery arranges four senior staff meetings a year, plus meetings for the whole staff group, day and night care staff and housekeeping staff. These were minuted, and planned dates for future meetings were in evidence. A supervision chart in the care office showed that individual supervision sessions with staff were planned and carried out by care leaders. Each session ended with setting a date for the next one, and the staffing rota showed where supervision time needed to be taken into account. Night carers were paid to go in early in order to receive supervision from a care leader before starting a shift. The home’s administrator kept records of personal monies kept in safe keeping by the home on behalf of residents. There was a sound receipt system in operation. There was a standard letter used to inform representatives, usually next of kin, of balances held, so they could choose when and how much to top up personal monies. Hairdressing and paper bills tended to be settled directly from personal cash. Current thinking is that people with dementia can get satisfaction from the experience of handing money for a service received. On trips out, people took £5 personal money, looked after by a care leader, who obtained receipts for any purchases people chose to make. The administrator and the manager carried out regular audits of the accounts in addition to yearly organisational audits. Very few pensions were collected for residents and records were kept of these transactions. Home managers are required by the Trust to carry out an annual quality survey of residents and their relatives. This had taken place in the home in July 2007, most responses being from relatives. Pat Lavery had produced an overview of responses, which showed measures that had been taken to address shortfalls identified. For example, the survey showed some people did not know about church services, so improved notices had been put up. Mrs Lavery has undertaken health and safety training. There were a variety of environmental risk assessments. The Trust had good systems in place to ensure approved contractors carried out routine servicing of the passenger lift, heating system and so on, on time. Trust managers made regular unannounced monitoring visits. These included checks on health and safety procedures and recording, including checking accident records, fire precautions monitoring and staff training in fire procedures. Anzac House was to have a fire training event for all staff in October 2007. All night staff were being trained as fire marshals.
Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 27 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 12 (1)(a) Requirement Timescale for action 31/10/07 2. OP26 13 (3) 3. OP38 13 (3) Pressure area risk assessments must be used in such a way as to demonstrate pro-active interventions that promote tissue viability and minimise risks of pressure damage occurring. Commode buckets must be 31/10/07 numbered to ensure they are always returned to the same user after cleaning. The registered person must 31/10/07 ensure that the safety of staff and residents is not compromised by the use of inappropriate blood testing devices. Recent information from the MHRA (Medicines and Healthcare Regulatory Agency) must be actioned. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 29 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. 4. 5. 6. 7. Refer to Standard OP9 OP12 OP18 OP19 OP26 OP26 OP35 Good Practice Recommendations A risk assessment should be completed for the security of the medication room, particularly with regard to the window, and any necessary remedial action taken. In care planning for activities or occupation, show in what ways activities will seek to enhance individuals’ well being, and set aims that can be evaluated periodically. Seek the advice and agreement of mental health professionals when devising behaviour management plans. Consider how to make the use of items such as soap and towel dispensers clearer to people with dementia. Consider fitting dining areas with alternative floor coverings to reduce the difficulties in keeping such areas clean. Give further attention to deployment of housekeeping staff in order to cover as much of the week as possible, including weekends. Through care planning, consider ways in which individual residents might be assisted to handle money in some situations. Anzac House DS0000028282.V340889.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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