Inspection on 02/05/05 for St Ann`s

This inspection was carried out on 2nd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Ann`s 11/06/07

St Ann`s 27/06/06

St Ann`s 01/09/05

St Ann`s 13/12/04

St Ann`s 13/04/04

St Ann`s 13/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE St Anns The Crescent Kettering Northants NN15 7HW Lead Inspector Kathy Jones Unannounced 02 May 2005 08:05am 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 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 Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Anns Address The Crescent Kettering Northants NN15 7HW 01536 415637 01536 415637 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Collycare Limited T/A B&M Care Mrs Teresa Hayward Care Home Only (PC) 39 Category(ies) of Older People (OP) 39 registration, with number Physical Disability - over 65 (PE(E)) 4 of places Dementia - over 65 (DE(E)) 21 St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 7 service users with Dementia may be accommodated on the First Floor. 2. A maximum of 14 service users with dementia may be accommodated on the ground floor. 3. A maximum of 4 service users with a Physical Disability can be accomodated on the first floor. Date of last inspection 13th December 2004 Brief Description of the Service: St Ann’s is a care home providing personal care and accommodation for 39 older people over the age of 65 years. The home is separated into two selfcontained units. On the ground floor, the home can care for 14 Older People who have dementia. On the first floor the home can care for Older People including up to 7, who have a mild form of dementia and up to 4 with a physical disability.Collycare Ltd trading as B & M Care owns the home.The home is purpose built and set on two floors, located in Kettering Town and within walking distance of the train station and town centre shops and amenities.27 of the bedrooms are single occupancy and 20 have en suite toilet facilities. A passenger lift provides access to the first floor.The home has a small enclosed garden which is well maintained and has a small raised fishpond accessed directly from the ground floor lounge. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the morning of a Bank holiday Monday. The inspection involved review of records relating to the assessment and planning of care needs and a sample check of accident records. Discussions with Service Users and observations of the daily routines and care provided were made. The Inspector spoke to Staff however did not meet with them on an individual basis in order not to disrupt the care provided to Service Users. Feedback was given to the Assistant Manager on duty on the findings of the inspection. No comment cards were received from Service Users or relatives/visitors prior to the inspection. The Inspector noted that forms were available in the entrance hall to the home on the day of inspection. A pre-inspection questionnaire was forwarded to the home for completion prior to the inspection requesting information to inform the inspection however to date this has not been received and the information will need to be evaluated at a later date. What the service does well: Staff were observed to be approaching and talking to Service Users in a respectful manner. Comments received from Service Users during the inspection confirmed that Staff treat them well. The lunch time meal on the day of inspection was freshly cooked and tasty and Staff were providing assistance to Service Users where needed. Adult protection procedures are followed and decisive action taken to protect Service Users. Areas of the home seen provided a comfortable environment for Service Users it was in good decorative order with comfortable furnishings and action was being taken to address maintenance issues. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 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 standard(s) 3 The home does not provide intermediate care therefore standard 6 is not applicable. The admissions process provides no assurances that Service Users needs can be safely met. EVIDENCE: The pre-admission assessment form for a Service User who had recently been admitted to the home was only partially completed. Without a full assessment the home would be unable to confirm that they could meet the Service Users needs. The section of the form, which summarises the care, needs to be met and to confirm the decision regarding admission had not been completed either. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 The shortfalls in the planning of care and instruction to staff have the potential to put Service Users at risk particularly in relation to meeting health care needs including pressure area care and dietary needs. EVIDENCE: Individual plans of care are in place for Service Users however these were very difficult to access as files for all Service Users from both floors were piled onto a trolley in no particular order. If Staff required information to guide them regarding a particular aspect of a Service Users care or a General Practitioner required any information from the daily record regarding recent health it would have been very time consuming and difficult to find the relevant information. Care plans for providing personal care were more detailed than seen on the last inspection. For example in one care plan more detail was included about the aspects of personal care the Service User was able to manage independently reducing the risk of staff taking away independence and dignity. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 10 Although there was an improvement in care plans relating to personal care more specific instructions are required to ensure that Staff are able to provide appropriate care. For example one care plan for a Service User who had lost weight contained the instruction to offer small appetising and tempting meals and to contact the General Practitioner. There was no information about the type of foods that the Service User enjoyed or consideration of introducing more frequent high calorie snacks, more regular weighing or evidence of contact with the General Practitioner. Failure to address the nutritional needs of individual Service Users could lead to unnecessary weight loss for the Service User. A food and fluid monitoring chart although not detailed in the care plan was in place however this indicated that there was up to a fifteenhour gap between the teatime meal and breakfast without any food or fluids being offered. A Service User was identified as receiving treatment for a pressure sore from the District Nurse almost two months prior to the inspection. There was no pressure area risk assessment or care plan in place and although the District Nurse had said she would order a pressure relieving mattress and cushion these were not in place. There was no evidence that this had been followed up by the home leaving the Service User at unnecessary risk of further pressure sores. Daily records are kept for each Service User, which record events, which have occurred in the day and note any particular concerns. These records are moved from the working care file at the end of each month. As this inspection occurred on the second day of the month, all but the previous days records had been removed, these were found in a pile in the office placed for filing which were again difficult to access as they were in no particular order. One of the purposes of these records is to be able to track any health care problems in order to take timely and appropriate action in referring any concerns to the General Practitioner and removing these records makes that difficult to do. A sample check of one Service Users records identified that there was nothing to indicate if a health care issue that had been noted on three consecutive days had improved. Failure to have accurate records, which are accessible, leaves Service Users at risk of recurring health care problems not being spotted and referred appropriately to the General Practitioner. Care plans for a Service User referred to the need to arrange appointments with an optician and a dentist however there was no evidence that these health care appointments had been arranged. Staff were observed to treat Service Users with dignity and respect and personal care was provided in the privacy of Service Users rooms. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The standard of the meals is good however due to the lack of individual assessment and planning some Service Users nutritional needs are not being met. EVIDENCE: From observations of the lunch time meal on the day of inspection the standard of the food is good. The meal was freshly cooked and a small sample confirmed that the meal was hot and tasty. The majority of Service Users spoken to confirmed that they were happy with the meals provided. One Service User spoken to said the portions were too large. Observations identified that meals are served on small plates, Staff advised that this is because Service Users prefer smaller portions however the Inspector noted that the small plates can give the appearance of a large portion and would suggest consideration is given to having a ordinary sized dinner plate. Staff were observed to provide Service Users with appropriate assistance with their meals without rushing them. As indicated in the previous section of this report more consideration and planning based on individuals nutritional needs is needed giving consideration to gaps between meals, weight loss, preference for small more frequent meals, St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 12 changing patterns for Service Users with dementia, likes and dislikes and nutritional content based on the needs of Older people. Following the inspection the Inspector has been told that Senior Staff and Catering Staff are to receive some nutrition training, which should improve Staff understanding and enable them to ensure that Service Users receive a diet appropriate to their specific needs. No specific activities were observed on the day of inspection however Staff on the ground floor were taking opportunities to engage with Service Users in conversation or impromptu dancing. Staff on the first floor appeared more tied up with care based interactions and were still assisting a Service User to be washed and dressed at eleven thirty leaving little time before lunch. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The Company have demonstrated that they will act decisively on complaints and any allegations of abuse in order to protect Service Users. EVIDENCE: The Commission for Social Care Inspection has received one complaint since the last inspection. The complaint referred to the mess in the building and the manner in which staff speak to each other and service users and lack of action by the Manager. The complaint was referred to the Responsible Individual for the company for investigation. Following the investigation additional support from Head Office and the Manager of another home was provided. Appropriate action has been taken to refer allegations of abuse under Protection of Vulnerable Adults procedures for investigation and swift action has been taken by the company to protect Service Users. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 The home was clean, comfortable, in good decorative order and appropriate action was being taken to address maintenance issues that had arisen. EVIDENCE: From a limited tour of the home there was a noticeable improvement in the standard of cleanliness within the home. Some Service Users spoken to confirmed that they are happy with their rooms and that they are kept clean. The areas of the home seen appeared in good decorative order and furnishings comfortable. At the time of the inspection carpets were found to be very wet in the corridor and one of the bedrooms however Staff were unable to establish the source of the leak. Contacts were being made with the Company maintenance Staff who visited during the inspection. A Service User was moved to a vacant bedroom not affected by the leak. Service Users did not appear to be affected by the problem. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 15 The tumble drier was out of action on this Bank Holiday Monday and Staff advised that it had not been working since Saturday. Later in the inspection the Inspector was informed that a new motor was planned to be fitted the following day. Due to the good weather Staff were able to dry the washing outside therefore Service Users were not affected on this occasion. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels are not maintained at a level, which provides adequate care and protection for Service Users particularly during Staff breaks. EVIDENCE: Requirements were made in the report of the previous inspection regarding staffing levels. Particular concerns were raised about the lack of cleaning Staff, which was having a serious impact on the standard of cleanliness in the home. This problem appears to have been addressed and although the home does not yet have a full complement of permanent cleaning staff they are using agency staff to make up the shortfall. The previous inspection report also raised concerns about the number of care staff on duty and gave an example of a period where one member of staff was responsible for 23 Service Users requiring varying levels of supervision and support during lunch breaks. The practice of leaving one member of Staff on the first floor during lunch breaks was found to be continuing. Discussion with Staff confirmed that this was not an isolated occurrence. Such low staffing levels particularly where some Service Users have dementia could put Service Users at risk. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The poor organisation and management of records and failure to review and act on information contained in the records creates a serious risk for Service Users health. EVIDENCE: Records and information regarding the care needs of individual Service users were difficult for Staff to access due to being piled together on a trolley. Crucial information regarding Service Users current well being was removed monthly from care files for archiving making it difficult to track any concerns from the preceding month. Removal of this information could mean that Staff are unaware of any ongoing concerns and lead to unacceptable delays in seeking medical treatment for Service Users. There was not an effective system in place for reviewing and acting on information detailed in Service Users records such as arranging health care checks and following up on advice given by health professionals. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 18 Accident records for all Service Users are kept in a bound book rather than individual records being kept on Service Users files. This method of keeping the records does not protect confidentiality or comply with data protection requirements. Food and fluid intake records for several Service Users were found to be left in one of the upstairs lounges, which is a breach of confidentiality. Copies of reports of monthly visits conducted on behalf of the Registered Provider are being forwarded to The Commission for Social Care Inspection on a regular basis. The purpose of these visits is to assess the care provided to Service Users and report back to the Registered Person in order that they are kept fully informed of the standards of care. The implementation of a full quality assurance system was not discussed during this unannounced inspection, as the Registered Manager was not present. As the previous inspection highlighted unmet requirements in relation to quality assurance a requirement has been made to submit details of the quality assurance system with a copy of the annual development plan. A robust quality assurance system is essential for maintaining and improving standards of care received by Service Users. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 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 Standard No 16 17 18 Score 3 x 3 x x x x x x 1 x St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 20 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 3 Regulation 12 (1) (a & b), 14 (1) Requirement Full information regarding a prospective service users needs must be obtained prior to a decision being made to admit them to the home. (Previous timescale of 15.01.05 not met) Up to date care plans must must be in place which cover all areas of care needs including nutritional needs and pressure area care and detail the required actions of the carer. Records must be reviewed regularly to ensure Service Users health is properly monitored.(Previous timescale of 15.01.05 not met) Details of the Quality assurance system and a copy of the annual development plan must be forwarded to The Commission for Social Care Inspection. Records relating to Service Users health and care needs must be easily accessible to Staff and organised so they can be used as a working tool. Timescale for action 07.06.05 2. 7,8 12 (1) (a & b), 17 (1) (a) schedule 3.3 (m,n) 12 (1) (a & b) 30.07.05 3. 8,37 07.06.05 4. 33 24 (1,2,3) 30.06.05 5. 37 12 (1) (a & b), 17 30.06.05 St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 21 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. Refer to Standard 8,15 37 Good Practice Recommendations Staff should receive training in the nutritional needs of Older People as soon as possible. Accident records should be comply with data protection legislation. St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Northamptonshire Area Office Newland House, First Floor Campbell Square Northants, NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Anns C51 C08 S12921 St Anns V223605 020505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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