Inspection on 11/09/07 for Augusta Court

This inspection was carried out on 11th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Augusta Court 23/06/08

Augusta Court 20/03/07

Augusta Court 30/09/05

Augusta Court 11/05/05

Augusta Court 24/08/04

Augusta Court 19/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Augusta Court Winterbourne Road Chichester West Sussex PO19 4TT Lead Inspector Mr E McLeod Key Unannounced Inspection 11th September 2007 09:15 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 Augusta Court DS0000014380.V344250.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. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Augusta Court Address Winterbourne Road Chichester West Sussex PO19 4TT 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) 01243 532483/584495 01243 771173 sharon.blackwell@anchor.org Anchor Trust Mrs Susan Pamela Hoskins Care Home 46 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (46) of places Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of one person in the category DE(E) (Dementia) over 65 years to be accommodated 20th March 2007 Date of last inspection Brief Description of the Service: Augusta Court is a care home in a residential area of Chichester providing personal care for up to 46 service users in the category of Older People. Augusta Court is a detached two-storey establishment providing 44 single and one double flat, each of which comprises of a bed, sitting room, kitchenette and shower room. Each floor has two distinctive wings with a lounge and on one wing, a hairdressing salon. A centrally placed lift gives access between the floors and the ground floor dining room, conservatory and offices. Anchor Trust voluntarily owns the service with their representative Mrs Jane Ashcroft appointed as responsible individual. There was not a manager registered for the service at the time of the inspection visit. Current fees are from £560 to £680 per week according to level of care needs. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was arranged to follow up requirements made at the previous inspection and to undertake a further assessment of how the home is meeting the key national minimum standards. The visit was undertaken by one inspector and lasted for seven and a quarter hours. Planning for the visit took into account information received on the service since the previous visit, including a CSCI annual quality assessment self-audit (AQAA) from the home which updated us on the service provided, and four CSCI survey forms returned to us by people living in the home. During the visit we spent time talking with nine people living in the home, to the manager and deputy manager, and to four members of staff. We also looked at four sets of care plans and other records relating to the care provided and health and safety in the home. We sampled three sets of staff recruitment and training records. We observed interactions between staff and people living in the home, and visited areas of the home including four bedrooms and the main communal areas. What the service does well: A good level of accommodation is being provided. The home has a good atmosphere. Good arrangements are in place for people to have their needs properly assessed before they are admitted to the home. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People living in the home say staffing levels are not meeting their needs, particularly at weekends. The home need to ensure that all areas of the home are checked for safety and up to date records are kept of these checks. A manager needs to be registered for the service to ensure that improvements continue to take place. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 7 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. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 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 Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have access to written information on the service which will help them make an informed choice about where to live. People are being admitted only on the basis of a full assessment undertaken by people competent to do so, and involving the prospective resident. Each person has an individual written contract or statement of terms and conditions with the home. EVIDENCE: Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 10 The statement of purpose, which provides information on the service and facilities people can expect when they come to live in the home, has been updated. People living in the home responding to our survey said that they had received a copy of the contract/terms and conditions of residence between the home and themselves. On the day of the visit, we were present when the home’s administrator was explaining the content of the contract/terms and conditions to the relative of a person soon to be admitted to the home. The provider has advised us that all prospective residents are given an assessment to assess their care needs. The pre admission assessment is carried out at Augusta Court by the Home Manager or Deputy Home Manager both of whom hold care management qualifications. On the day of the inspection visit a prospective resident was visiting the home as planned, and a pre-admission assessment was being carried out by the deputy manager. Supporting information such as physiotherapy and tissue viability assessments had been requested as part of the assessment process. We sampled four assessments carried out previous to admission and these indicated that people’s needs are being fully assessed before admission to the home is agreed. The provider has told us that prospective residents are invited to view the home, have a meal and spend a day there prior to moving into the home. Information from the provider has advised us that respite holiday care is provided, but specialist intermediate care is not being offered. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: At the previous inspection, we found that people were not having their care needs regularly reviewed. The self-audit information we received from the provider told us that social interaction lifestyle plans and night check agreements have been introduced into the service user plans. They also told us that assessments of need and record sheets to record health care are included on the plan. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 12 We looked at four sets of care plans and found these included regular reviews of the care plan and risk assessments. The individual care plan is now being held in the person’s bedroom, where they and their relatives can easily access it. It was noted on the day of our visit that a senior carer was undertaking a preplanned review of a care plan with the person receiving the care. While not all care plans seen had yet been updated to the new format, which provides clearer guidance to staff on providing care to the person, there was sufficient evidence to indicate that people’s care needs are being more regularly reviewed. The previous requirement made in respect of this is now assessed as met. It was noted that health care interventions and appointments are now being outlined in the service user plan to ensure appointments are not missed. Surveys we received from people living in the home indicated that they felt their health care needs were being met. At the previous inspection we found that arrangements for the administration of medicines were not as safe as they needed to be. During this visit, we found that storage arrangements for medicines have been improved. A system for assessing safety where a person is administering their own medicines has been commenced, and this can help support the person’s independence. A training programme is in place to ensure that all staff who help administer medicines are trained to do so, which includes an assessment of competence. Managers now also audit medicine records more routinely to ensure arrangements are safe. The previous requirement made in respect of medicine arrangements is now assessed as met. One person living in the home said she felt “treated with dignity” by staff, and other people we talked to also felt their privacy and dignity was being respected. Managers told us that everyone in the home holds a key to their bedroom. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 13 Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet people’s expectations. EVIDENCE: In the previous inspection report we said that not all people living in the home were having their need for activity and social interaction met. A full time activity co-ordinator has been appointed since the previous inspection. She is offering support which is helping people to maintain their interests and an active lifestyle. People we talked to said many more activities were being provided than previously, and one said that the activities co-ordinator was “always thinking Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 15 up something new”. The activities planned are posted in communal areas, and activities provided include Tai Chi, a dance & exercise group, drama and reminiscence. On the day of the visit a coffee morning was being attended by 12 people living in the home, and after this a number of people were supported to go on a local walk. The local church comes into the home monthly offering a communion service. Several people we talked to felt that more regular opportunities for religious observance could be provided, such as weekly hymn singing. The managers of the home said they were happy to consider these and other suggestions which would assist people to maintain their faith. People we talked to said the standard of food had been improved by the appointment of a permanent chef, and that more choice was being provided at meal times. The provider had told us that the chef manager and relief cooks receive training in nutrition for older people and the preparation of suitable menus. On the day of the visit we noted that specialist needs, such as soft food diets, are being catered for. We observed a lunch during our visit, and noted that all people who needed assistance with their meal were receiving this. There was a relaxed and sociable atmosphere in the dining room. For the lunch there was a choice of two main dishes, and two desserts, and people decided at the table which choice they would have. People received smaller portions if they asked for them, and were able to help themselves to the freshly cooked vegetables available at the table. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: People living at Augusta Court who we talked to told us that they know how to make a complaint, and feel their concerns or complaints would be dealt with fairly. At the previous inspection we found that many staff had not been trained in protecting people against abuse. During this visit, the manager provided evidence that most staff have now been trained in protecting people against abuse, and that managers are accessing training in local adult protection procedures. This requirement is now assessed as met. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 17 Staff talked to us about how people in the home are being protected from harm, for example when people who would be at risk on their own leave the building. During the visit this happened, and a member of staff accompanied the person out and ensured their safe return. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable and safe environment and have bedroom accommodation which promotes their independence. Shared spaces complement and supplement the person’s individual room. EVIDENCE: Augusta Court is purpose built and provides accommodation in flatlets for up to 46 residents. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 19 The flatlet accommodation is arranged in four wings, and colour schemes have been used to assist people with orientation. The four flats we visited had been personalised to suit each person’s needs. All rooms have an en suite bathroom and kitchenette. There are three sitting rooms on the first floor, one sitting room and a conservatory on the ground floor, and a large dining room and an accessible paved garden area. People living in the home are encouraged to be involved in the planning and care of the garden within their ability, and are assisted in this by the activities co-ordinator. The local fire service has inspected the home, and a requirement for new front doors to the each flatlet and an additional fire break door on the ground floor was being carried out on the day of the inspection visit. Arrangements are in place for maintenance work to be logged and carried out in the home. The premises continue to be well maintained. The provider has advised us that infection control procedures are now in place, that hand washing is promoted at all times and training takes place at induction. All parts of the home visited were clean and hygienic, and people we talked to said the home was always clean and fresh. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a need to review staffing levels to ensure that all the needs of the people living in the home can be met at all times. People are protected and supported by the home’s recruitment policy and practices. People living in the home benefit from a well supported and supervised staff team, who have access to relevant training. EVIDENCE: At the previous inspection, we were concerned that people living in the home were at risk through staff not being up to date with fire training, and staff not being provided in sufficient numbers. We also said there were risks to Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 21 residents through staff working long shifts, and not receiving the supervision, training and support they are in need of. Before this visit, the managers advised us that in recent months 10 new staff, including a new chef manager, had been recruited. This has resulted in fewer agency staff covering duties, and suggests a more consistent level of care can now be offered. Managers advised us of increases in staffing levels, and told us that senior staff are expected to be more accessible and visible in the home. The majority of people living in the home who we talked to felt however that there were insufficient numbers of staff, especially at weekends. One person described staffing at weekends as “more chaotic”, and that the home lacked a management presence at weekends. Staffing rotas we sampled indicated that generally the manager and deputy manager do not work weekends, and the manager confirmed that because housekeepers do not at present work weekends this could lead to people thinking that there are fewer staff on at weekends. At the previous inspection we had some safety concerns around staff working double shifts. Staffing rotas we sampled indicated that double shifts are still being arranged to cover staff shortages at times. This may indicate the need for more staff. Care staff we talked to during our visit felt that they did not have time during a shift to spend time talking with the people they cared for, and this was also the perception of a number of the people living in the home. Surveys we received from people living in the home and interviews on the day of the visit indicated that a number of residents find some staff difficult to understand (for example, staff talking too quickly) and that some staff have difficulty in understanding them. The deputy manager told us that training in communication is being provided for all staff, and that the home is considering making use of local colleges to improve spoken and written English. We sampled four sets of recent staff recruitment records, and these indicated that required references and checks are being obtained before staff begin Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 22 work. Managers told us that staff undertake a probationary period when they start work, and that the induction programme for new staff is accredited. We sampled staff training records, and these indicated that gaps in staff training identified at the previous inspection, such as fire training, have been addressed. The previous requirement made in respect of this is now assessed as met. The provider has told us that staff supervisions take place monthly and that there is an annual personal development review. Care staff we interviewed confirmed that regular supervision and staff meetings are now taking place. The provider has told us that of 16 care staff employed, eight have achieved the national vocational qualification (NVQ) at least at level 2, and eight staff including some senior staff are presently undertaking NVQ qualification training. The previous requirement made concerning this is now assessed as met. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A manager needs to be registered for the service to ensure that improvements continue to take place. The management approach of the home creates an open, positive and inclusive atmosphere. Health and safety arrangements in the home would be improved by more rigorous environment checks. EVIDENCE: Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 24 The previous manager left her post in August 2007, and at the time of our visit the new manager had been in post for three weeks. Many of the improvements to the service noted in this report had been initiated by the deputy manager (who has been in post since March 2007). People living in the home who we talked to felt that the service had significantly improved since the appointment of the deputy manager and manager, one person saying they were “people people”. A member of staff interviewed said they were providing good leadership and were approachable. The manager advised us that he will be applying for registration with CSCI. The previous requirement made in respect of management cover is now assessed as met. One person living in the home said there was “no unfairness”, and everyone we talked to felt there was a good atmosphere in the home. At the previous inspection we were concerned that incidents that should have been reported to us were not being reported. Records held by the Commission indicate that significant incidents are now being reported to us, and this requirement is now assessed as met. At the previous inspection, we were concerned that action was not always being taken to address incidents of injury to people living in the home. The provider has advised us that an audit of the cause of falls in the home has been undertaken, and a plan to reduce falls was put into place (which included staff training). We are also advised that regular exercise classes and a walking for health programme to build strength and stamina have been introduced in the home, and on the day of our visit a short local walk was undertaken with a number of residents. Measures taken have also included checking footwear and ensuring regular eye tests. Managers advise us that here has been a marked reduction in falls Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 25 since February 2007. The provider has told us that servicing and checks on equipment are taking place at intervals recommended by the manufacturer. We looked at records for environmental safety checks in the home, the most recent one having been carried out in July 2007. We noted that checks recorded did not include the safety of bedrooms. A requirement has been made concerning this. Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X X 3 X 2 Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18.1 (a) Requirement Timescale for action 30/11/07 2. OP38 13.4 (a) The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall 30/11/07 ensure that all areas of the home are checked and made safe where required, and up to date records are kept of these checks. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Augusta Court DS0000014380.V344250.R01.S.doc Version 5.2 Page 29 - 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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