Inspection on 12/07/07 for St Anne`s Nursing Home

This inspection was carried out on 12th July 2007.

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 Anne`s Nursing Home 30/11/07

St Anne`s Nursing Home 09/08/06

St Anne`s Nursing Home 22/09/05

St Anne`s Nursing Home 16/12/04

St Anne`s Nursing Home 14/09/04

Similar services:

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

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

CARE HOMES FOR OLDER PEOPLE St Anne`s Nursing Home 60 Durham Road London N7 7DL Lead Inspector Pippa Canter Unannounced Inspection 10:00 12 July 2007 & 23rd July 2007 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 St Anne`s Nursing Home DS0000010329.V345564.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. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Anne`s Nursing Home Address 60 Durham Road London N7 7DL 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) 020 7272 4141 020 7263 0952 nelia.nabeebaccus@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Ms Nelia Nabeebaccus Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. For the Provision of General Nursing care for up to 40 Frail Elderly People aged 60 years and over. The Staffing Notice For the provision of personal care for up to 20 frail elderly people Unannounced Key - 9th August 2006 Pharmacy Inspections 11th July 2007 Date of last inspection Brief Description of the Service: St Anne’s is a residential care home with nursing. The home provides longterm care for up to 50 frail people over the age of 60. There are currently 37 places for people who require nursing care and 13 for people who require personal care only. The residential beds include two for respite care. The home can use up to ten beds flexibly for either personal or nursing care and still operate within their registered categories. This is particularly useful as it means that people in the residential beds can stay at the home when their needs increase. The home is situated in Islington and is accessible by both bus and tube networks. The home was purpose built in 1997 and is accessible to wheelchair users. The property is over three floors, with service user accommodation being on the first and second floor. All bedrooms are en-suite and meet statutory requirements for space and size. Residents have their own letterbox and doorbell. The home provides 24 hour staffing covered by registered nursing staff and trained support workers. The home is owned by Anchor Homes an established national, not for profit, provider of housing and support for older people. Islington Primary Care Trust (PCT) and the London Borough of Islington jointly commission the service. The range of fees will be recorded in the final report when the level of fees has been supplied by the service. bearing in mind that social services individually assess each service user to decide their fee. Staff from the Primary Care Trust assess each person for eligibility to receive a NHS contribution to their nursing care. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted over a day and a half and lasted about 10 hours. ’Recently, the Commission was made aware of concerns raised by a relative of a resident about the lack of care her mother received. Whilst this was not the purpose of this key inspection to investigate the concerns raised as such, the concerns raised have been considered when assessing the relevant National Minimum Standards. These concerns are currently being investigated by Islington Primary Care Trust and Local Authority under Stage 2 of their complaints procedure. The Commission will await the outcome and decide what further action may be necessary.’’ Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment completed and returned by the registered manager. We reviewed and summarised the incident and monthly reports supplied by the home. Postal questionnaires were circulated for people living in the home, relatives as well as health and social care professionals. Twenty four surveys were returned, thirteen of which had been those for people living in the care home. Unfortunately eleven of these recorded that staff had assisted with the completion of the surveys. In the absence of direct comments from residents and all the responses being positive, then this information was not considered very valuable. During the first visit the premises were toured initially with a member of staff and then several times on an unaccompanied basis. People living in the service and staff were spoken to and the serving of lunch was observed and there were other periods of observation throughout the first day. Prior to this inspection, a Pharmacist from the Commission for Social Care Inspection did an in depth examination of the ordering, receipt, administration and disposal of medication. A separate report has been sent to the home but an overview is contained within this report. Staff were observed going about their duties and interacting with residents. The inspector observed a handover on one of the units. Seven care plans were looked at and compared with the care being provided. Service users were asked for their views about living in the home and staff were also interviewed about aspects of care, staffing levels, supervision, complaints and adult protection. Staff recruitment, supervision and training records were looked at on the second day. All those who have contributed to the inspection process are thanked for their input. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The most significant improvement is the management of medication in the home. Staff were found to take a positive attitude towards the pharmacy inspections. To have the medication arrangements scrutinised had acted as a focus to improve their relationship with the GP and the pharmacist and this in turn had improved the service and practices in the home. There are now very good recording systems and thorough auditing. Following meetings with the GP and pharmacist systems are now well organised with a rolling review of medication being conducted. Care plans include information about the racial origins and cultural and linguistic backgrounds of people who live in the care home. It is clear that staff try to meet the resident’s religious and cultural needs where possible. A St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 7 church minister visits regularly but also people can attend their specific church. A comment received was “She keeps her independence…………and it helps her to keep in touch with family and friends. She is also able to go to Church at least once every couple of months. Overall she seems very happy.” The service try to ensure culturally appropriate meals are provided. What they could do better: This inspection has identified that some of the staff in the home do not provide a consistently good standard of care. On the whole staff are motivated to work in a professional way. Feedback from people living in the care home and those that visit relates to the fact that some carers are very kind as well as friendly and cheerful. This has the implication that some are not. There is a clear differentiation between the staff who are interested and engaged with the residents and their families and others “who are not necessarily unkind but do not show the same commitment”. Most visitors have found the staff to be “polite, welcoming and helpful” whilst some have found “some are not”. The staff have access to training therefore should have the knowledge and “the skills to care for residents of a mixed range of needs.” However it is clear, in a couple of instances, that staff have not taken appropriate action in response to changing health care needs at the time they occur.; although later they have made referrals for health care professionals. There have been occasions when some staff have failed to uphold the privacy and dignity of some of the residents in their care. This indicates a lack of a person centred approach towards the residents and families, some staff not using training to underpin their approach and simply not reflecting on what is good or poor practice. This kind of lack of attention needs to be addressed through competency assessments and a more structured supervision approach. In order to show transparent management arrangements all relatives should be informed of how to make a complaint and staff must be clear in the reporting mechanisms under the adult protection procedures. Further work is required to make sure that staff in the home are fully conversant with prevention of cross infection prevention and are able to support residents appropriately in relation to their end of life decisions. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 8 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. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most people moving into the home can be reassured that their needs will be assessed and their aspirations and wishes can be met. EVIDENCE: The service has both a statement of purpose and a service user guide, both of which are known to accurately describe the current service available in the home. The pre-inspection information suggested that the service user guide may be taken forward in digital format (i.e. take the form of a virtual tour) for hearing impaired and possibly a talking book format for visually impaired. Discussions with people living in the care home revealed a mixed response as to the information they had received about the service prior to admission. Some recalled being visited by a staff member but could not recall receiving a service user guide. It was noted that service user guides are not on show in the lobby nor are copies available in residents’ rooms. However one individual St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 11 confirmed that their relatives had visited and looked around and then they themselves made a visit to the home. Feedback from the relatives confirmed that they were in receipt of information about the service prior to admission. This inspection identified a similar issue identified in the previous inspection report. The manager recorded in pre-inspection information that as a result of a block contract with the local authority, the service is under pressure to accept admissions that are outside of the category of registration. The manager also feels that given the pressure on time, it was not always possible for the care service to go and meet new referrals and complete a preadmission assessment. This aspect of care and perception from the home is being discussed as part of the active engagement with the Commissioners of the service. The registered persons must be able to prove their continuing fitness by only admitting people whose needs can be met within the service. Case tracking shows good practice is taking place in respect of the sample of admission assessments. Seven care files were looked at, including the most recent admissions; and each one contained a pre-admission assessment completed by the referring agency and one filled out by the home. Feedback from a social care professional was, “Usually the assessment arrangements ensures that accurate information is gained and the right service is planned and given to the individual.” During the first day of the site visit, a nurse had arranged to visit a day centre to assess a person referred for short-term care. Staff confirmed that they undertake pre-admission assessments and documentation was available to support this for people who had been referred for respite care. The care home has responded to the requirement made at the last inspection to include information relating to race, culture and belief systems. The home was able to meet the care needs of those people whom the inspector case tracked however it was confirmed by staff that the care service finds it difficult to meet the needs of people with cognitive impairment such as dementia. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The changing health care needs of the people living in the service are not always recognised and proactively addressed by staff in the home. Medication is now being administered to ensure the safety and well being of residents. EVIDENCE: Seven case files were looked at and the service users spoken to. A comparative study was made between the care being provided and the care records. Some aspects of care were discussed with the people using the service. The findings were fed back to the person in charge on the day and the Regional Manager for Anchor Trust. Prior to this key inspection, a Pharmacist from the Commission for Social Care Inspection visited the home to do a follow up inspection from February 2007. Overall the assessments seen were sufficiently detailed enough and identified wishes and preferences. The seven care plans looked at represented a range of needs including diversity, racial origin, gender and health needs. Care plans are clear and kept up to date with evidence of monthly reviews being recorded St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 13 or as required to meet changing needs. They also document wishes and preferences. Generally the assessments and care plans reflected the person’s needs in relation to disability, gender and health needs and these were being followed through so that the level of care was the same as recorded on the care plan. The inspector did receive comments such as “They give my mother excellent care 24/7. She is kept very clean and comfortable. They meet the many needs my mother requires.” And “They look after individuals with great care.” However it is clear that some people living in the home may not be having their needs met in a consistent way. Comments were received which supported the evidence found by the inspector. These were “Sometimes they forget my father has sight and hearing difficulties.” “Not always contacting correct people for the problem in hand, or even recognising there is an issue to be seen to.” There have been incidents whereby peoples’ health needs have not been properly addressed. This includes staff not taking steps to investigate the weight increase of one resident and not including specialist advice from a Speech and Language Therapist. (This is Requirement 1) The manager has recorded in the pre-inspection information that the relationship with the local GP surgery is not as good as it could be. This is being resolved by meetings to discuss ways in which the home and the surgery can work in partnership. Although the GP was sent a survey, this has not been returned. The care home has a clear protocol for calling the GP in response to changing health care needs, however it has been reported that requests to see the GP are not listened to and residents are left alone for long periods when feeling unwell. The relationship between the home and the GP is cited as a possible cause for staff not bothering the surgery. Generally feedback from care managers and relatives have identified that when issues are raised then the staff will be responsive. However staff need to be proactive rather than reactive to the changing health care needs of the residents. This year the home has had two full inspections by a Pharmacist from the Commission for Social Care Inspection. The first on 28th February 2007 was organised in response to six medication errors made by some of the nurses when administering medication to residents. This pharmacy inspection identified nine areas that required serious improvement. The second inspection was a follow up to assess what improvements had been made to make sure medication was handled safely. This second inspection took place on 11th July 2007 and the Pharmacist reported a marked improvement in medicines management. There were robust audit processes in place. No gaps were noted for receipts, administration or disposal. Disposal was witnessed by two nurses. Dosage changes were signed and dated by the GP and were case tracked to records of doctors notes in the care plan. There were records of training and competency assessments. All the requirements made at the previous inspection were inspected and all had been met. The outcome of the St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 14 pharmacy inspection shows that the home has worked well with the GP, pharmacist and Primary Care Trust to improve medicines management in the home. The GP visits weekly and continues a rolling review of medication. Three recommendations were made as opposed to the nine requirements in February 2007. The recommendations have been included in this report. A copy of the pharmacy inspection report has been sent to the care home a copy of which can be made available on request. ` Feedback from service users and relatives confirmed that staff treat the people they care for with respect and that their right to privacy is upheld. Each single room has a bell. Staff were not observed waiting for an invitation to enter a room but pressed the bell as a warning and then entered the room. Discussions with care staff highlighted that because of the frailty of some residents that it was not always possible to get an acknowledgement. Generally people living in the home confirmed that staff respect their privacy and dignity. Interviews with specific staff highlighted that they understood the values of privacy and dignity and gave good practical examples of how they promote these for residents. However during the site visit the inspector observed that these values did not underpin every staff member’s practice. Examples were a staff member using an infantile term when asking if a resident wanted to go to the toilet; shouting at a resident to sit down and staff not responding promptly when told a resident wanted to go to the toilet. A comment from a visitor was that they had seen residents sitting on commodes because the bedroom door had been left open. (This is Requirement 2) An examination of the care records showed that end of life decisions had been recorded however these did not always reflect cultural and personal influences. One of the concerns raised had been whether clear instructions had been recorded in respect of the residents’ wishes about resuscitation. (This is Requirement 3).Staff training records show that CPR training has been attended but with all training, competency needs to be assessed. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care home continues to offer a varied and balanced diet with alternatives to the main menu. In general the care home meets the needs and wishes of individuals in respect of their daily life and social activities however this is not being done consistently. EVIDENCE: The manager supplied information about the flexibility of daily living and the activities with the annual quality assurance assessment, which was supplied as part of the pre-inspection information. Care plans were inspected and people living in the service were asked about how they organised their day. The activity organiser was busy during the site visit so the inspector was unable to have a word with her. However a comment was received from a relative, which was “The lady who organises the entertainment is very well thought of by my grandmother. She works extremely hard.” People living in the home spoke about the varied programme of activities and confirmed that they have the choice to participate or not. Most said that there St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 16 is something for everyone on the programme. The inspector also met with a couple of residents who like attending the local day centre. Although during the site visit the activities were evident, the inspector did not observe much interaction between the staff and those residents not attending the bingo session. In one lounge, four service uses had been left watching a film on the television. They were not actively engaged in the film and a member of care staff recognised this. The offer of turning off the television was made and the radio was switched on. However the radio station was one that played popular music only. The inspector felt that this was a missed opportunity to engage residents in reminiscing about the music they like to listen to. The care plans seen, recorded the preferences of people in respect of their lifestyle and discussion with residents confirmed that choices are respected. Feedback from a social care professional also supported the judgement that people living in the service are not receiving a consistent approach in this outcome area. The feedback was, “I placed a person in the home but was disappointed that likes and dislikes had not been recorded. Any information relating to preferred lifestyle was sparse and only a couple of words recorded. No one in the home had spent time talking to this individual to find out what their preferences were. They expressed a preference to sit in their room and listen to the radio but would be in the main lounge with the television.” (This is Requirement 4 which relates to both Standard 12 & 14)) However another comment received was, “St Anne’s respects the wishes of the individual resident with regards to their daily routine e.g. getting up and going to bed, even if this conflicts with the views of the resident’s relatives.” The home provides telephone points in all rooms as well as SKY connection point. Relatives said they are welcomed into the home although one comment received was “Staff are friendly (most of the time).” This implies that some staff are not welcoming. However pre-inspection information supplied by the manager confirmed that the service has open visiting and have rooms available in which relatives can stay and there are also private lounge areas. Relatives are also invited to join their loved ones for meals. One of the periods of observation carried out in the home was at lunchtime. People living in the home and relatives gave a range of views on the quality and variety of the meals. This ranged from “Excellent” to “They seem to serve a lot of chicken”, to “The only thing the home needs to improve is the food really. My ****** complains every time I visit but does not like to make a fuss. This is now being dealt with.” An inspection of the menu showed that it is varied and choices are available including alternatives to the main menu. People from ethnic backgrounds confirmed that they liked the food and that culturally specific meals can be available. A monthly fine dining experience is incorporated into the menu. The assessment process includes a nutritional tool to assess if residents are at risk of malnutrition. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. To ensure that people living in the service are protected at all times, a consistent approach must be available for addressing complaints and in particular adult abuse. EVIDENCE: The complaints log was examined and the complaints’ process was discussed with the management representative at the time of the site visit. People living in the home were asked about their life in the home and what they would do if they were unhappy about any aspect of their care. The manager of the care home must inform the Commission of Social Care Inspection (CSCI), of any untoward incident inclusive of accidents, deaths, serious illnesses and any allegations of abuse. During the site visit, the incident and accident records were inspected and these were cross-referenced with care plans, reports to the Commission and complaints records. Information held about the home shows that there has been a responsive attitude towards complaints with the home keen to learn from mistakes and correct poor practice. The Commission is aware that there is an ongoing investigation following concerns raised by a relative. Although the home has investigated the original concerns, there is dissatisfaction with the conclusions in the report. An independent person from the Islington Primary Care Trust is investigating the complaint. We will await the written report before discussing St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 18 the outcomes with the providers, Anchor Trust and any implications for continuing fitness. Feedback from nine relatives showed that three of them did not know how to make a complaint. The pre-inspection information confirms that the complaints’ procedure is documented in the statement of purpose, notice boards, leaflets and the service user guide. However copies of the statement of purpose and service user guide is not obvious in the home. A relative commented, “ I have never been told how to raise a complaint, but if there was an issue, I would contact one of the care workers in the staff office.” (This is Requirement 5) A leaflet with a complaints procedure gave a wrong impression of the role of the Commission in investigating complaints. The management representative at the time of the site visit agreed to remove the leaflet from circulation. When care staff were asked what they would do if they received a complaint they said they would refer the person to the nurse in charge. Although this is reasonable action, it would be preferable if the staff would sit and listen to the resident’s concerns. If a complaint is referred directly to a nurse, some residents may see this as though they are “making a fuss” and not simply exercising a right. People living in the service said that generally their concerns were listened to and staff were responsive. Complaints are logged and records show that investigations are carried out and remedial action taken where it is indicated. Complaints are also analysed as part of the quality assurance process. Records supplied as part of the inspection showed that 43 staff attended adult protection training between 23.03.06 to 22.06.06. Discussions with staff showed that they understood the concepts of adult abuse but not all would report an incident immediately preferring to speak to the perpetrator first. Most were clear about reporting incidents to the manager but were not aware of reporting outside the home. In order to ensure that residents are protected fully, all staff must be familiar with the interagency procedure for adult protection. (This is Requirement 6) St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. People living in the home can expect a comfortable and clean environment. The proposed developments for the prevention of cross infection in the home should be a priority to ensure the safety of the residents and staff. EVIDENCE: The pre-inspection information supplied by the manager confirmed that since the improvements made to the home in the last 12 months include the redecoration of 15 bedrooms and the communal areas as well as replacing all the mattresses. There are future improvement plans, which includes the installation of unit bathrooms, the refurbishment of the four unit kitchens, air conditioning in the lounges and replacing curtains in residents’ bedrooms. It also includes confirmation of a home maintenance programme supported by a surveyor team. During the site visit the home was toured several times during St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 20 the site visit. This took in communal areas, bathrooms and the bedrooms of people being case tracked. The latter was done with the person’s permission. The care home was purpose built. It has a secure entrance and full disabled access although the double set of doors can be a hindrance. Further security is provided by the installation of CCTV monitoring the perimeter of the home. All bedrooms are single occupancy with an ensuite consisting of a toilet, shower and hand basin. Each bedroom door has a doorbell. There are communal assisted bathrooms for residents who prefer a bath. The corridors and doorways are wide enough to take wheelchairs. It was observed during the site visit that the shape and layout of the lounge-cum-dining rooms were not conducive for residents to engage in small groups. The need for access, the increase in the number and size of wheelchairs and other aids and adaptations encourages the placement of chairs against walls around the lounge area. There was a mixed response from relatives about the environment. The diverse comments received were “I would suggest that the home requires some general maintenance/repair/cleaning. The carpets are beginning to look tired and worn out and there is a smell of urine in the air” to “Keeps the environment of the home very clean.” On the day of the site visit, the home was clean and tidy and there were no obvious odours detected and overall the carpets looked clean. The care home notified the Commission for Social Care Inspection that two people had been admitted from hospital with the same infectious illness. The home contacted the Health Protection Agency for support and advice. However feedback from health care professionals and evidence found by the inspector on the first site visit was indicative that staff in the home did not fully comprehend understand the prevention of cross infection procedures. Although infection control notices were posted on the bedroom doors, there was no sign of gloves or aprons at the entrance to each room and there were arrangements for disposal. Protective clothing was being stored in a cupboard. The inspector spoke to a relative visiting one of the people affected. They had been told that they must wear protective clothing if having personal contact with the infected person but this was stored in a cupboard in the corridor but they did not feel comfortable about searching through it. The infection control procedures seen on the day of the inspection were not current but published in 2001 and due for review in 2004. There are current procedures, which need to be disseminated to all staff. (This is requirement 7) It is acknowledged that there has been no spread of the infectious illness. One of the people affected by infection spoke very positively about the care they were receiving and this was echoed by the visiting family member. The pre-inspection information sent by the manager confirms that there will be a review of the Department of Health “Essential Steps to Infection Control” and an action plan will be developed for all the care homes within the Anchor St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 21 group. Developments will include a new hand washing training programme and audit, an audit tool for homes on infection control processes and a system to monitor and collate transferable infections. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 22 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. The people living in the care home are not receiving a consistent service from the staff. The systems in place to ensure continuity are not being used effectively. EVIDENCE: Staff were observed carrying out their duties and interacting with people in their care. Relatives and people living in the home were asked for their views. The inspector received feedback from health and social care professionals through the surveys. Recruitment and selection files, induction, supervision and training records were looked at. Some staff were asked about their recruitment, training opportunities and levels of support; others were asked about aspects of care and whether the staffing levels were appropriate to meet the dependency levels of the residents. An examination of the recruitment and selection records and an interview with a newly recruited staff member clearly identified that there is a robust and thorough process in place. The process includes a job description, person specification, standard interview questions with a written record and the candidate sits a written test. The process is designed to test out the candidate’s attitudes and transferable skills. All new employees are engaged on a trial period with probationary interviews conducted. Not all the written St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 23 records of these interviews clearly evidence the conduct and performance of the new recruit. An induction process is in place based on the Skills for Care framework with a workbook and record, which is cross-referenced to the National Vocational Qualification (NVQ) framework. Interviews with staff and training records showed that training opportunities are in place. Comments about staff were both positive and negative feedback concerning the staff. Feedback included remarks such as, “They give my mother excellent care.” “They look after individuals with great care.” Residents said that some staff are “good”, with the implication that other staff are not. One resident said that one staff member is argumentative whenever they make a request. A survey recorded similar incident “Some service users needs are ignored. A staff member refused to provide tea at 10.00am as requested by the service user. The staff member said that the service user would have to wait until the rest of the residents have their tea, which was much later.” A comment from a relative was that some staff are friendly and welcoming, which again implies that some staff are not. Records show that two complaints have been made about staff attitude, both of which have been taken seriously and addressed. (This is requirement 8 and includes Standards 28 & 30) The staffing levels were looked at as part of the inspection process. The rotas were looked, the deployment of staff was discussed and people involved in the service were asked for their views. There was again a mixed response. Generally people felt that there was sufficient staff. Some staff commented that good teamwork ensured that the delegated tasks were complete; other staff members felt that the levels were sufficient to complete routine tasks but left no time for meaningful socialisation and interaction with residents. Comments received were: “ A review highlighted that the person would like to sit out in the garden but the reply from the care home was that there was not enough staff to do that.” “More trained staff available at busy times e.g. morning, breakfast, lunch and tea. From observation on the day of the site visit and the accumulated evidence there is a case for reviewing the staffing levels in the home. A recommendation has been made. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 24 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. In order to ensure continuity and effective management, there should be a review of staff competencies and management systems. EVIDENCE: Prior to the site visit, all the information held by the Commission for Social Care Inspection was looked at, inclusive of monthly reports, notifications of accidents and incidents. Staff, residents, relatives and visiting professionals were asked for their views. Management staff were observed during the visit. As part of an independent investigation the registered manager was not present in the home. The Commission for Social Care Inspection has been St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 25 kept informed of developments by Anchor Trust of alternative management arrangements within the care home. We await the outcome of the independent complaints investigation and an internal enquiry by the provider. Although there is a clear management structure within the care home, however this is not considered to be effective. This judgement is made based on the evidence that the outcome for residents’ health and personal care is poor; there is a lack of supervision for some staff and they are not meeting the standards for complaints and protection. The inspection has identified that a review of staff competencies needs to be implemented to ensure continuity and effective management. (This is requirement 9) Staff said that the home had a good atmosphere and that the manager was approachable and supportive. Arrangements for managing service users’ monies are suitable. The provider has an established quality assurance process, which seeks the views of people living in the home. There is evidence that changes to the service have been made as a result of listening to people who use it. There is evidence that individuals are not receiving a personalised service and it is clear that monitoring systems are not being used effectively to measure whether the service is meeting its’ own statement of purpose. (This is Requirement 10) Interviews with staff confirmed that formal supervision is carried out and confirmed the benefits in respect of their professional developments. These are recorded. An examination of the supervision records did not support a routine and systematic approach. The sample of records examined recorded topics, which had been discussed but there was no clear evidence that the supervisor had checked out with the supervisee that they had understood the training nor how they would implement it as part of their practice. This is an area that needs to be looked at given previous recorded evidence in this report i.e. the failure of nurses to address weight gain in a resident, six medication errors, examples of privacy an dignity not being upheld and complaints about the attitude of staff. (This is requirement 11) Anchor Trust carry out regular health and safety audits. Reports and action plans are complied after each audit. A sample of health and safety records were taken and these were found to be accurate. Equipment is being serviced on a regular basis and fire prevention is being taken seriously. However previous evidence recorded in this report has clearly shown that staff were not following current practice in respect of the prevention of cross infection. St Anne`s Nursing Home DS0000010329.V345564.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 27 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. 1 Standard OP8 Regulation 12(1)(a) Requirement The Registered Manager must ensure that the changing health care needs of people living in the home are addressed promptly. The Registered Manager must make sure that staff act in a manner that respects the privacy and dignity of the people living in the care home. The Registered Manager must make sure that the end of life decisions reflect the cultural, religious and belief systems of the person who is dying. There must be clear instructions recorded as to want action the resident wants in respect of resuscitation. Staff must be more vigilant about making sure that they give all people living in the care home opportunities to exercise choice and follow a preferred lifestyle. The Registered Manager must make sure that all stakeholders must be aware of how to make a complaint. The Registered Manager must ensure that all staff know and DS0000010329.V345564.R01.S.doc Timescale for action 31/10/07 2. OP10 12(4)(a) 31/10/07 3 OP11 12(3),(4) 31/10/07 4 OP12 OP14 12(3) & 16(m) 31/10/07 5 OP16 22 31/10/07 6 OP18 13 (6) 31/10/07 St Anne`s Nursing Home Version 5.2 Page 28 always follow the reporting procedures in the local authority policy and procedure on the protection of vulnerable adults. 7 OP26 OP38 16(j) The Registered Manager must make sure that staff are implementing current cross infection procedures. 18(1)(a) The Registered Manager must make sure that staff are competent to meet the assessed and changing needs of the people living in the care home. 9(a)(b)(i) The Registered Provider must take appropriate action to make sure that the care home is being managed effectively. 17, 22, 24 The Registered Persons must make sure that the quality assurance and monitoring systems are being used effectively. This includes getting feedback from residents and staff. 18(2) The Registered Manager must make sure that supervision sessions are used not only to identify training needs but also to check out that staff have understood the training they have attended. 30/11/07 8 OP28 OP30 31/12/07 9 OP31 31/12/07 10 OP33 30/11/07 11 OP36 30/11/07 St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP27 OP9 OP9 OP9 Good Practice Recommendations It is strongly recommended that the provider review the staffing levels and deployment in line with assessed needs. That nurses sign the Controlled Drug register with their full signature rather than just an initial. That the medication profiles are update regularly That the GP/Pharmacist is requested to write the full instructions for Morphine Sulphate tablets on the MAR. St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 St Anne`s Nursing Home DS0000010329.V345564.R01.S.doc Version 5.2 Page 31 - 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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