CARE HOMES FOR OLDER PEOPLE
St Anne`s 21 Wayside Road Southbourne Bournemouth Dorset BH6 3ES Lead Inspector
Jo Palmer Unannounced Inspection 10:15 12 January 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000020496.V276440.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000020496.V276440.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Anne`s Address 21 Wayside Road Southbourne Bournemouth Dorset BH6 3ES 01202 425642 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) Mr M J Lingam-Willgoss Mrs N Lingam-Willgoss Mrs N Lingam-Willgoss Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places DS0000020496.V276440.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: St Annes is a care home providing nursing and personal care for up to eighteen older people. Situated in a quiet residential road in Southbourne close to local amenities. There are sixteen single rooms, eight of which have en-suite facilities and one double room. There is a communal lounge area on first floor although this is not used very much by service users, a desk at one end provides staff with office space. A passenger lift and two staircases provide access between the floors. A kitchen is centrally sited on the ground floor from which all meals are prepared and other utility areas (laundry and food stores are in an adjacent building. Outside the home there are small gardens to the front and rear with a small parking area to the front. Mr and Mrs LinghamWilgoss are the registered providers (owners) of St Annes, and Mrs LinghamWilgoss also takes the role of manager with the support of a deputy manager. DS0000020496.V276440.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection on 12th January 2006 lasted for four hours. At the start of the inspection, the sister in charge was present who called the deputy manager who arrived shortly afterwards to assist with the inspection process. Mrs Lingham-Wilgoss , one of the joint owners and registered manager arrived at 12.30 to provide additional information and discuss the inspection. This was a brief inspection the purpose of which was to monitor progress in addressing requirements and the recommendations of the last inspection and to review practices in relation to some of the National Minimum Standards. Not all standards were assessed and the reader is referred to the report of the last inspection dated 27th June 2005, which can be obtained either from the home or from www.csci.org.uk The inspector spoke with seven residents, one visitor, two trained nurses, the manager and deputy manager, took a tour of the premises and examined relevant records. What the service does well:
The home’s brochure provides sufficient information for residents and prior to admission residents needs are assessed. Care plans are generally well written and provide basic instruction for staff regarding how care needs are to be met, some attention is required as detailed below. Medication is managed well in the home and procedures are in place for the protection of residents. Residents spoken with confirmed that they are treated respectfully and that their rights are protected. Families and friends are kept informed and residents confirmed that they are allowed to receive visitors at any time. Social and leisure programmes are dependent on the individuals wishes, preferences and abilities to engage in self determined activity. St Anne’s is clean and well maintained and residents live in a safe, pleasant environment where they can have their own things around them. Communal space is available although little used by residents, bathrooms and toilets are sited around the home and provide necessary aids for accessibility. There are sufficient numbers of staff on duty and residents confirmed they are always attentive. The ration of trained nurses to care assistants appropriate for the current needs of residents. DS0000020496.V276440.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
This inspection has identified several areas of concern where improvement is needed and requirements are made: Prior to admission, residents must be assured in writing that on the basis of information obtained at the assessment, the home has the staff skills, services and facilities to meet their needs. Resident assessment information must indicate where the information was obtained. Where a resident is unable to contribute to the assessment process, the member of staff obtaining the detail of the persons needs, must identify the reliability of the information provided. Care plans must detail all aspects of care and direct staff as to how to meet the needs of the resident, in this instance, catheter care plans must be in place to ensure the catheter is well maintained and ensuring against the risks of introducing infection. Although Mrs Lingham-Wilgoss confirmed that residents at the home have not required locks to bathroom doors and that vacant/engaged signs would be provided, this inspection found that bathroom doors remain without locks or signs, this potentially compromises the privacy and dignity of residents, it is therefore a requirement that appropriate locks are fitted. Care staff must receive training by a competent trainer in issues relating to adult protection and the means of identifying and reporting any suspicions of abuse. A system for reviewing the quality of care and services provided must be established to ensure the home is meeting its aims and objectives and a development plan must be in place identifying how action will be progressed within agreed time-scales. This inspection has also made the following recommendations. The duty rota should identify staff roles within the home including cleaning and catering staff.
DS0000020496.V276440.R01.S.doc Version 5.1 Page 7 It remains a recommendation from the last report that documented evidence is available form the training provider to evidence that the induction and foundation training programmes are run in accordance with national Training Organisation workforce training targets. 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. DS0000020496.V276440.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000020496.V276440.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable. Residents and their representatives are assured of accurate information about the care and services provided at St Anne’s prior to admission. Prior to admission residents care needs are assessed to enable them and the registered persons, determine whether St Anne’s is able to meet those needs, the decision is not however formally notified to the resident. EVIDENCE: Although not directly examined during this inspection, a copy of the home’s Statement of Purpose and Service User Guide are held on file with the Commission, a copy briefly seen at inspection evidenced that this had been updated in order to remain current. Mrs Lingham-Wilgoss confirmed that other information in the Statement of Purpose had not changed since the last inspection, which reported that sufficient information was available to inform residents and their representatives of care and services provided at the home. Care files examined detailed pre-admission information including an assessment of health and welfare needs. The deputy manager confirmed that a member of staff form the home visits the prospective resident to identify their needs and determine whether St Anne’s would be suitable. The source of
DS0000020496.V276440.R01.S.doc Version 5.1 Page 10 information obtained is not recorded and the residents or their representatives are not asked to sign the assessment indicating their agreement with the outcome. There is no formalised method of informing the resident following assessment that the home is suitable for meeting their needs. DS0000020496.V276440.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care plans generally provide sufficient detail for staff to be aware of resident’s health and welfare needs and how to meet them although caution is needed to ensure the review process is consistent and that identified needs remain current. Residents are not consulted with regard to the assessment and care planning process and cannot therefore be assured that the home will continue to meet their needs. There are satisfactory arrangements for managing medication in the interests of residents. Resident’s rights are respected and their right to privacy is supported through care delivery, relationships with staff and confidential record keeping practices. EVIDENCE: Following assessment, resident’s care needs are detailed in a plan of care outlining for staff how needs are to be met. Care plans examined detailed most health and welfare needs of residents although some had not been updated or reviewed in light of the changing needs of the resident and some care plans were not specific enough to provide staff with care instructions. For example, the care plan for one resident who required assistance with mobility informed
DS0000020496.V276440.R01.S.doc Version 5.1 Page 12 staff that they ‘need to maintain limited movement’; there was no specific instruction as to whether this resident required the assistance of one or more staff, any equipment that may be necessary or other considerations that would assist in safe transfers for the resident and staff involved. One care plan referred to the residents toileting needs and had not been updated in respect of the catheter the resident now had. There were no care plans detailing the catheter care needs of residents identifying catheter maintenance and reducing risks of infection. Of the care files examined, night care plans provided very comprehensive detail of how needs are to be met and considered the residents preferred night routines including evening entertainment, drinks, preferred time of retiring and waking and preferred breakfast. Night care plans also detailed any personal care intervention including moving and handling and continence needs. Examination of records kept daily in respect of care provided for residents demonstrate how care needs are met by staff on a daily basis, these records demonstrate the daily lives, routines and significant events of residents at St Anne’s. Residents spoken with confirmed that staff in the home met their care needs appropriately. Following two requirements of the last inspection, medication management procedures now adopt good practice in accordance with Royal Pharmaceutical guidelines. Records of medicines received into the home, administered to residents or disposed of when no longer required were well maintained and storage of medication was secure. Residents spoken with confirmed that they felt a kind and caring staff group treated them with respect. DS0000020496.V276440.R01.S.doc Version 5.1 Page 13 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 are supported in maintaining contact with their friends and families and are able to decide on their daily social and leisure activities in the home as far as their health and general abilities allow. EVIDENCE: Care records examined demonstrated that the social needs of residents had been considered. The social calendar for St Anne’s was not examined although it was apparent from speaking with residents that social care is not provided with organised group activities. Those residents that were able to comment stated that they were able to arrange their own social and leisure activities and enjoyed books, magazines, television etc. some residents had formed friendships and visited each others rooms. Residents confirmed they are able to receive visitors at any time and some confirmed that they are able to go out with friends and family. DS0000020496.V276440.R01.S.doc Version 5.1 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): None of these standards were assessed directly; the reader is referred to the previous inspection report which assessed these standards as met. EVIDENCE: DS0000020496.V276440.R01.S.doc Version 5.1 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, 23, 24 & 26 St Anne’s provides a comfortable, safe environment for those living there and visiting. The home is clean and well maintained. Sufficient space is provided for residents, toilet and bathing facilities are accessible and aids and adaptations are in place to meet resident’s mobility needs. EVIDENCE: St Anne’s is suitable for its stated purpose, the home is safe and well maintained and meets residents individual needs. Programmed maintenance schedules are in place for the servicing of equipment including the lift, hoists emergency call system and electrical equipment. Mrs Lingham-Wilgoss confirmed that other aspects of the home’s maintenance are undertaken as required, bedrooms are redecorated and have new carpets laid when they become vacant and communal parts of the home are decorated as required. Mrs Lingham-Wilgoss confirmed that furniture is replaced as it becomes necessary. A new boiler was installed and the front drive way re-laid in 2005. Mrs Lingham-Wilgoss confirmed that an occupational therapist carried out an assessment of the premises in 2003 and recommendations from the report of
DS0000020496.V276440.R01.S.doc Version 5.1 Page 16 the assessment have been actioned ensuring that environmental considerations were in place to aid accessibility. Grab rails and other aids are available in communal areas to aid resident’s movement around the home. A passenger lift provides access between floors. There are sixteen single rooms and one double room, the double room and eight of the single rooms have en-suite facilities. Room sizes vary between 10.01m² and 16.51m² and the shared room is 19.21 m². (not assessed on this occasion, information held on file with the Commission) Bathrooms, showers and toilets are sited conveniently around the home with suitable aids for assisting residents; bathrooms do not however have locks. A recommendation of the last inspection is repeated as a requirement to ensure the registered persons address the matter of respecting resident’s privacy and dignity. Sufficient communal space is available although this is not used by residents who confirmed they prefer to stay in their rooms. Staff are provided with appropriate hand-washing facilities and information is available regarding infection control procedures. The laundry service was not inspected although residents confirmed that items are taken for laundry appropriately and returned clean and in good condition. DS0000020496.V276440.R01.S.doc Version 5.1 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 & 30 The number of staff employed and the ratio of trained staff to care assistants is sufficient to meet the needs of residents. Regular attendance at staff training events helps develop staff skills that are necessary for them to carry on in their roles. EVIDENCE: Mrs Lingham-Wilgoss confirmed that staffing levels have not changed since the last inspection which reported that there is one trained nurse on duty on each shift with three care assistants in the mornings, two each afternoon and one each night. Additionally, the deputy manager works between two and three shifts each week for management and administrative duties (the rest of her working week being on shift as the trained nurse) and Mrs Lingham-Wilgoss works for several days each week; Mrs Lingham-Wilgoss’ time in the home varies each week but is now demonstrated on the rota. Rotas also show who is on duty for catering and cleaning although their roles are not identified on the rota. The last inspection made the recommendation that Mrs Lingham-Wilgoss obtain evidence that the package of training purchased, is organised in accordance with National Training Organisation workforce training targets for care staff. Mrs Lingham-Wilgoss confirmed that she had spoken with the training organisation who have confirmed that their induction and foundation training does meet the specified standards, this however is not documented. Mrs Lingham-Wilgoss was advised to ensure that to keep abreast of changes to the expected standards of training for care workers in social care, she visit the
DS0000020496.V276440.R01.S.doc Version 5.1 Page 18 ‘Skills for Care’ web site and was provided with information on the new Common Induction Standards. Mrs Lingham-Wilgoss confirmed that five members of staff have been through the current induction and foundation training programme that the home operates, additionally, five staff have completed a health and safety course, three carers have attended a safe handling of medicines course and all staff have completed first aid courses. All trained nursing staff have done adult protection although no care staff have done this training. DS0000020496.V276440.R01.S.doc Version 5.1 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): 33. Quality assurance and quality monitoring systems are not in place to ensure residents are receiving a service in their best interests. EVIDENCE: Standard 31 was not assessed although it was evident that a recommendation of the last inspection had been addressed; as manager of the home, Mrs Lingham-Wilgoss is now identified on the staff rota which demonstrates her hours in the home. Mrs Lingham-Wilgoss stated that a quality assurance programme had been undertaken although records were not available for inspection; there has been no development plan as a result of any audit. Mrs Lingham-Wilgoss stated that questionnaires had been sent to residents and relatives in order to gain their views of the care and services provided, results of these have not been audited and other aspects of service provision have not been measured to ensure the home is meeting its stated aims and objectives.
DS0000020496.V276440.R01.S.doc Version 5.1 Page 20 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 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 X 17 X 18 X 3 3 3 3 3 1 X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X X DS0000020496.V276440.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement The registered person shall confirm in writing to the service user that, having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. Previous time-scales not met 30/06/04, 30/10/04, 03/02/05 and 07/07/05. This is the fifth time this requirement is repeated. The registered persons must ensure there is a system of identifying the source of information obtained at the preadmission assessment process and that the resident or their representative is party to the process indicating their agreement with the outcome. Where a service user is in receipt of catheter care, a care plan must be available detailing the action to be taken, when, by whom and how often. Previous time-scale not met 07/07/05. This is the second time this requirement is repeated.
DS0000020496.V276440.R01.S.doc Timescale for action 1. OP3 14 31/03/06 2 OP3 14 31/03/06 3 OP7 15 31/03/06 Version 5.1 Page 22 4 OP24 12 5 OP30 18 6 OP33 24 Bathroom doors must be fitted with locks to ensure the protection of resident’s privacy and dignity. All staff must undertake training in adult protection including reporting procedures should any form of abuse or neglect be suspected. The registered persons must establish and maintain a system for reviewing and improving the quality of care in the home, a report of any such review must be provided to the Commission and be available to service users. 31/03/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations Staff roles should be identified on the duty rota to show in what capacity they are working. In order to demonstrate that staff employed are competent and have the skills to do their jobs, it is recommended that the registered persons obtain evidence that the induction training meets National Occupational Workforce Training targets and introduce a foundation training programme. 2 OP30 DS0000020496.V276440.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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