Inspection on 08/11/05 for St Agnes Retirement Home

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

St Agnes Retirement Home 10/05/05

St Agnes Retirement Home 08/12/04

St Agnes Retirement Home 12/07/04

St Agnes Retirement Home 30/03/04

St Agnes Retirement Home 05/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Agnes Retirement Home 7 Neva Road Weston Super Mare North Somerset BS23 1YD Lead Inspector Carolle Wise Scanlan Unannounced Inspection 8th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 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. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Agnes Retirement Home Address 7 Neva Road Weston Super Mare North Somerset BS23 1YD 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) 01934 621167 royorme@yahoo.com Mrs Gail Joanne Norton Mrs Doreen Hiley, Mrs Kim Elizabeth Vowles To be appointed Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Age of persons who may be received in the home - 65 years and and over May accommodate two people who are aged 59 years and above, who may also have a learning difficulty. This condition applies to specific residents and will no longer apply should these residents leave. 10th May 2005 Date of last inspection Brief Description of the Service: St Agnes is a retirement home providing care for a total of 24 service users. The home provides care for those residents of 65 years old and for two people with learning disabilities. St Agnes is situated in a quiet residential area of Weston-Super-Mare. It is within easy reach of the town centre area, has local shops, parks and the sea front nearby. The house stands in gardens to both the front and rear. The accommodation is arranged over two floors, the first floor accessible via a stair lift. The basement area contains its laundry, workshop storage and staff room facilities. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a full day and a separate morning. The inspector met with six residents. St Agnes has been without a registered manager for a period of two years. During this period of time there have been three registered manager designates. Over the last eighteen months however, the homes management have had a period of stability, with the same management staff, but with a change in their roles. Roy Orme is the registered manager designate with plans to attend a ‘Fit Person’ interview in 2006 with the commission. A ‘case tracking’ methodology’ was used for the purpose of the inspection. Records, which must be kept by the home, were sampled and reviewed. What the service does well: What has improved since the last inspection? Care plan documentation and risk assessments over the last eighteen months have significantly improved. There is however further room for improvement in the detail of the care plans. The staff have ensured that there are risk assessments in place for each resident, which are regularly reviewed. Adult protection awareness, although not yet undertaken by the staff is now planned for January 2006. Job descriptions regarding the Registered Manager designate and Care Manager have been devised. The staff are aware of the need to complete POVA checks and referencing prior to new staff commencing employment. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 4. Residents are able to make a choice about living here based on the information provided and visiting the home. Residents have their needs assessed prior to moving into the home to ensure their needs can be met by the home. EVIDENCE: Residents who recalled initially moving into St Agnes said they received enough information about the home before they chose to live here. One resident stated that ‘it’s much better to visit the home, as pictures and brochures don’t always give you the feel of a place’. Prospective residents are encouraged, where able, to visit the home and meet the staff and other residents prior to making their decision to move in. Residents have a months trial period a ‘test drive’ to see whether it suits their needs. There have been no changes made to the Statement of Purpose or Service user guide and the manager stated that these are reviewed to ensure they reflect the current facilities and service provided. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 9 Resident’s needs are assessed prior to moving into the home by the registered manager designate or the care manager. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 10 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. Care plans and risk assessments, although improved, need further detail to be added, to be in line with the actual care provided and to safeguard the residents. Medication procedures were not in line with good practice and improvements are needed. Residents are respectfully treated with account made to ensure their privacy and dignity. EVIDENCE: Care plans are in place for all residents. These are reviewed on a monthly basis and drawn up with the resident’s involvement. The staff and home have made significant improvements in developing their care plans and risk assessments over the last twelve months but further improvement is needed. Resident’s care on discussion with some residents and staff exceeded that which was written. As an example, a resident who requires assistance with diabetes management had very little written in his care plan to reflect the St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 11 staffs ‘delegated’ role. The specialist nurse wrote guidance for the management and monitoring of his diabetes but no reference was made to this in the care plan. There are potential risks to the residents when some of the care information is communicated verbally. More detail in the care plan documentation and risk assessment is needed to further safeguard the residents. The manager must ensure that the staff are trained and competent to undertake any delegated role. Where it is noted by the staff that there has been deterioration in the health of a resident, referrals to the appropriate health and social care professionals are made, with the residents involvement and consent. A few residents suffer short-term memory loss and the inspector suggested that the resident’s health in this regard is monitored regularly and referrals made where appropriate. On discussion with the manager it was evident that residents annual reviews by the General Practitioners have not taken place. It was suggested that this is discussed further with the residents GPs. The homes medication procedures on the day of the inspection had not been adhered to. Medications had been ‘pre-potted’ for administration later in the day, which the inspector was advised was not normal practice. Medication is supplied by Lloyd’s pharmacy in weekly NOMAD boxes. A list of staff trained to administer medication should be available with their signatures. Insulin is stored in a locked box within the general fridge. Resident’s medication could not easily be audited as no signed record was made on the Medication Administration Record (MAR) sheet of the stock received or remaining stock. Night sedation is stored in a portable locked box within the medication trolley this could be made more secure by fixing the box to the trolley. Residents appeared relaxed and comfortable in the staffs’ company. Gentle, and appropriate humour had developed between staff and residents, some of whom have lived at St Agnes for many years. Staff were observed knocking and awaiting replies prior to entering residents rooms. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 12 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 Residents exercise choice over their daily routines. The homes activities are arranged to meet the resident’s preferences. EVIDENCE: Chatting with the residents and staff during the inspection it was clear that a great deal of thought goes into the activities offered to the residents. On the day of the inspection the activity organiser suggested ‘knitting’ or ‘crochet’. The inspector found residents who were able, enjoying this session. Residents who were not able to join in were laughing at the staff and manager who were. To summarise a residents’ comment staff were ‘all having a go but were hopeless’. A really happy and vibrant atmosphere and ambience was created throughout the home with all the chuckles and laughter. Some residents have arrangements for social activities in the local community, such as church events or attending day centre groups. A variety of activities are organised, generally an hour prior to ‘tea’ each day. ‘Line dancers’ entertain the residents about three times a year and outings are arranged with smaller groups of residents. Several residents attend to their own entertainment and some choose not to attend arranged activities. Resident’s social and activity preferences are recorded in their care plans but attendance at activities is not generally recorded. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 13 Families and visiting is open, with feedback suggesting that they are made to feel very welcome. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 14 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 The residents felt confident that any complaints or concerns would be listened to and taken seriously. EVIDENCE: There are safeguards in place such as a complaints procedure. Residents met felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager Roy Orme was very approachable and would deal with any issues no matter how minor there and then if he could. The home keeps a record of any complaints made and since the introduction of the ‘niggles book’ in the lounge area there have been no comments written either by residents or relatives. The complaints procedure notice was posted on the wall in the hallway and within the Service User Guide. There is also a copy of this made available in the large lounge room. The manager arranges to see every resident each Sunday to gather his or her views, thoughts and opinions. It was suggested at the last inspection that all staff receive adult protection awareness training as good practice. The manager stated that the next course is due to commence in the New Year and that this was in hand. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 15 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, 20, 21, 22, 25 & 26 Resident’s benefit from a comfortable and pleasant home undergoing further improvement and investment currently. The homes maintenance checks need to be improved to ensure that they remain up to date. EVIDENCE: The home smelled clean, looked homely, pleasant and tidy. The accommodation is arranged over two floors with the basement area for staff use only. There are hand grab rails in several areas for the resident’s convenience and safety. All radiators seen were covered with low temperature surfaces. Water temperature checks are undertaken on a regular basis. The home does not employ a maintenance person currently. Any maintenance jobs are listed in a book; outside contractors are then sourced to undertake the work. The manager and the proprietor undertake to complete the homes regular maintenance checks. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 16 The communal rooms are on the ground floor. Off the reception hallway is the stairwell and chair lift to the first floor. There is one private bedroom on the mezzanine area, which has steps to navigate and is accessible only to more ambulant residents. The spacious open plan lounge/dining room leads off the hallway and over looks the rear garden. There is also a smaller lounge with the same outlook, which is often used for musical entertainments. The kitchen has a hatch opening into the lounge area and a lobby area with a door that leads down into the basement. The basement houses the homes laundry, staff room and a room used by maintenance. The laundry floor finishes should be impermeable and together with the wall finishes readily cleanable. At the time of the inspection the home was renewing its electrical wiring and systems and the head height for staff in the lobby area of the basement was restrictive. The inspector suggested that further advice be sought from local Development and Environment officers. Good practice was noted in the use of aprons, gloves and hand washing. The bathroom on the first floor has a hoist that was in a poor state and needs replacing. The steps on the landing area should form part of the homes general risk assessments. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 17 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 Staffing levels should be reviewed and based upon the resident’s levels of dependency and care needs to ensure that they can be met. EVIDENCE: The core staff team remain committed to providing consistent care for the residents, with 55 of staff having achieved NVQ Level 2. Staffing numbers however continue to be an issue at the home, with two further care staff vacancies to be advertised. Three staff are on duty each morning, two of an afternoon and one waking staff member with a sleep-in manager on nights. The manager’s hours were discussed further. The sleep-in night cover is provided by the manager who has to be in residence from eight in the evenings, however he is not expected to provide cover on his days off duty. The manager has advertised one carer post, which he hopes to interview for within the next few days. Staff currently ‘backfill’ the staffing vacancies to enable consistency of care to the residents. However, the manager felt that the use of agency staff may be needed should the vacancy not be filled. Calls bells were answered promptly during the inspection. A few residents did remark that at times such as in the mornings and early evenings the staff are busy but felt they did not have to wait an ‘overlong time to be seen to’. It was suggested that the staffing numbers are reviewed to ensure that the residents needs can be safely met. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 18 St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 19 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, 32, 35, 37, 38. Residents and relative’s views are valued and taken account of by the homes manager. The manager needs to develop further understanding of the areas in which the home needs to improve and devise a plan to meet these. EVIDENCE: Roy Orme is the registered manager designate, who has completed the majority of his NVQ Level 4 course. He is well respected and liked by all the residents who find him easy to approach. Residents remarked that if ‘you ask Roy to do something he acts on it straight away, you can rely on him’. Staff find the manager approachable and benefit from this leadership. The management structure of the home is of the Registered Manager designate and the deputising role is that of the Care Manager. These roles should be clearly defined in the job descriptions. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 20 Residents have regular meetings with the staff and the manager sees each resident on a one to one basis at least once a week to gather their opinions and views. The proprietor has started to complete and forward regulation 26 audits to the commission, this must be undertaken on a regular monthly basis. Residents monies are not managed by the home but by the residents themselves or their representatives. Residents ‘petty cash’ money is kept safe in a lockable unit. The residents can request to have their money at any time. A receipt book is kept and monies are signed for by two people. Towards the end of the inspection an ‘outburst’ in an argumentative voice was clearly heard, this was a staff member. The manager attended to the situation well and the staff member later apologised to the residents who overheard her. This staff member has since left the homes employ. Records are stored in a lockable office. The offices within the home have been rearranged. The registered manager designates office now lies off the reception hallway and is compact. The administration office remains and the Care Managers office is off the mezzanine area on the first floor. Fire signage to direct residents to the first floor mid landing fire exit is needed. General risk assessments of the homes environment and safe working practices need to be undertaken and updated. Bathroom hoists must be regularly serviced and maintained with records kept. Equipment stored in the kitchen lobby area must be locked and stored appropriately under COSHH. A smoke detector is needed in the staff designated smoking area. Fire procedures and risk assessments must be in accordance with Avon Fire Brigade guidance, as one staff member according to records seen had not received fire safety training since December 2004. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 21 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 X X 3 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 1 St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 22 Yes 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 OP7 Regulation 15(2) Requirement Care plans must reflect how the resident’s needs in respect of health and welfare are to be met. Risk assessments should be translated into the plan of care to be provided. E.g. Risk assess ‘Voluntary’ job undertaken by a resident. Receipt of all medicines into St Agnes must be recorded. Timescale for action 21/12/05 2 OP8 13(4)(c) 21/12/05 3 4 5 OP9 OP32 OP22 13(2) 8 23(2) (c) 21/12/05 6 OP27 18(1)(a) Registered manager is to be 21/01/06 appointed. First floor bathroom hoist to be 21/12/05 replaced and regular service records of the hoist must be kept. Residents who receive care by 21/12/05 the homes care staff ‘delegated’ by other health Care professionals, must receive appropriate training, be assessed as competent in the role and clear guidance in place from that health care professional on the delegated tasks. This must also be reviewed regularly. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 23 7 OP33 26 8 OP38 23(4) The proprietor when not in dayto-day charge of the home must at least once a month carry out an unannounced visit to the home and carry out the visit in line with regulation 26. The fire exit on the first floor landing needs an appropriate sign to highlight the exit. A smoke detector is needed in the designated staff smoking room. All staff must receive fire safety training in line with Avon Fire Brigade Guidance. Chemicals stored in the lobby area at the back of the kitchen must be kept in appropriate lockable storage following COSHH. A written statement of the policy, organisation and arrangements for maintaining safe working practices should be in place. Risk assessments must be carried out for all safe working practice topics. 21/12/05 21/12/05 9 OP38 13(4) 21/12/05 10 OP38 23(2) 21/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP9 OP9 Good Practice Recommendations It is recommended that a list of signatures of all staff administering medicines be kept in the medicine file. It is recommended that steps be taken to ensure that the same person puts medication out, administers it and then signs the medicine administration record sheet. Residents who self-administer medications, including that DS0000045717.V260018.R01.S.doc Version 5.0 Page 24 St Agnes Retirement Home 4 5 6 OP16 OP27 OP38 of creams etc should be risk assessed in line with the Royal Pharmaceutical Guidance. Adult Protection awareness training for all staff members Staffing levels to be reviewed to ensure that all residents needs can be met. Advice to be sought from the Development and Environment officers with regard to basement laundry and environment. St Agnes Retirement Home DS0000045717.V260018.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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