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Inspection on 22/09/05 for St Anne`s Nursing Home

Also see our care home review for St Anne`s Nursing Home for more information

This inspection was carried out on 22nd September 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Registered Manager left the home in very competent hands of one of the Team Leaders who was the Person-in-Charge in the morning, and also the Deputy in the afternoon. The home is smart and clean. Staff were courteous and considerate and treated service users with respect. Policies, procedures and records were up to date. The Statement of Purpose and Service User Guide were well written and particularly useful for residents. Induction and training for staff is good and enable staff to deliver a good and competent service. Eight comment cards were returned and generally were positive.

What has improved since the last inspection?

Jugs of water and juice were on tables for service users. The temperature of the room where medication is stored is monitored.

What the care home could do better:

Communication from the registered manager to staff could be looked into to ensure staff are included in the safe running of the home. Safety of residents in relation to staffing ratios should be reviewed. A comment card from a resident said "there are not always enough staff". Eight comment cards were received from residents which indicated that there were not always enough activities. A visit from Head Office to meet with staff could be considered.

CARE HOMES FOR OLDER PEOPLE St Anne`s Nursing Home 60 Durham Road London N7 7DL Lead Inspector Ms Franki Solomon Unannounced Inspection 22nd September 2005 10:00 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.V252583.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 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 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.V252583.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. For the provision of personal care for up to 20 frail elderly people For the Provision of General Nursing care for up to 40 Ffrail Elderly People aged 60 years and over. The Staffing Notice Date of last inspection 20th June 2005 Brief Description of the Service: St Anne’s is a residential care home with nursing. The home provides long term care for up to fifty elderly residents. The home is situated in the Borough of Islington and is accessible to public transport. The nearest tube station is Finsbury Park in North London which is approximately 20 minutes walk away. The home is owned by Anchor Homes an established national, not for profit provider of Housing and support for older people. The service is commissioned by Camden and Islington Primary Care Trusts and the London Borough of Islington. The home was purpose built in 1997 and is accessible to wheelchair users. The property is over three floors, separated into four units. All bedrooms, known as flatlets are en-suite and meet current 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. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection of the year for April 2005 – 30 March 2006. The inspection was unannounced. The Registered Manager was away for the day on training and the Deputy Manager was off duty until the morning and came on duty in the afternoon. The inspector met with one of the Team Leader’s who assisted with the inspection until the Deputy arrived. The inspection was over one day and lasted 6 hours. The inspector looked at service user care plans, policies and procedures, spoke with some staff and with some service users. The inspector would like to thank all staff and service users for their hospitality and assistance with the inspection. What the service does well: What has improved since the last inspection? Jugs of water and juice were on tables for service users. The temperature of the room where medication is stored is monitored. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this occasion. The key standards were assessed at the last inspection. EVIDENCE: St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 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 the following standard(s): 10. The home ensures service users are treated with respect and service users are confident their views and wishes are observed. Those rooms seen were personalised to the service users’ tastes. Resident follow their own pursuits as and when they wish where possible and within reason and safety. EVIDENCE: All arrangements, policies & procedures in terms of Privacy & Dignity were in place. Service users spoken to expressed their satisfaction and said they were treated with respect and had no complaints. They felt their privacy and dignity were observed. Residents were engaged in their own pursuits or remained in the lounge with others. Staff were observed to interact with staff in a manner which was respectful and considerate. Staff knocked on doors and waited to be invited in. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 10 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): 13 St Anne’s is successful in meeting the needs of service users in respect of ensuring their contact with family and friends. More outings could be arranged. EVIDENCE: Arrangements were in place for family, friends and visitors. The inspector spoke with a few residents who expressed satisfaction with arrangements for contact with whomever they wished. Some did express they felt there were not enough activities and said this was probably because there were not enough staff to do this. Comment cards were sent out, 5 service users indicated there were not enough outings, and that they would like to go out shopping more. On the day of inspection most of the residents were seen to be sitting around in the home. No entertainment took place that day. The inspection was unannounced, the manager was away for the day and the inspector was therefore not able to discuss this with the manager. The deputy handed the inspector St Anne’s staffing rota which indicated the home met the minimum staffing guidance. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 11 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): Not assessed on this occasion. EVIDENCE: St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 12 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): Not assessed on this occasion. EVIDENCE: St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 13 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): 29. The home’s recruitment practices are safe to ensure service users’ safety. Communication systems in the home could be improved to ensure the safety of service users and staff in the home. EVIDENCE: Arrangements, policies & procedures were in place. A sample of staff files were inspected. Anchor Care’s recruitment procedures ensured that staff were vetted before commencing employment. Criminal Records Bureau (CRB) checks were undertaken and two references. The registered manager and the administrator who have their office on the ground floor were away on the day of the unannounced inspection. The inspector rang the bell and asked for the manager by name via the entry phone. The lock on the door was released and the inspector entered the home. There was no one to meet her. The inspector waited a few minutes, and then wandered around downstairs on the deserted floor until she entered the laundry room where she met the laundry staff member. The staff member asked for identification and took the inspector upstairs and introduced her to the person in charge, namely one of the Team Leaders. The team leader apologised. A staff member did come forward later that day to say she had released the catch on the door because she had not known the administrator too was out with the manager and that the ground floor was unattended. The staff member had understandably, assumed the administrator would meet the ‘visitor’ (the inspector). Although the absence of the manager and the St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 14 administrator was recorded in the communications book, the information was not known to all staff working on other floors and who were able to release the front door. Because of the lack of communication (no one to admit the inspector at the door) the inspector was not required to sign the Visitors Book. This is unsafe practice and not only puts service users at risk but also staff. The Team Leader too, did not know the whereabouts of the registered manager, only that “she was at a meeting all day – but she can be contacted by mobile phone”. It is good management practice that the registered manager and senior staff provide staff with as much information of their whereabouts so that in the event of an emergency, the person-in-charge or staff may first contact the most accessible and nearest senior management staff. A recommendation has been made. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 15 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 & 35. The home meets the national minimum standards. EVIDENCE: The home has a quality assurance system and seek the views of residents. A comment card from a service user said “not always enough staff”. According to a sample of service users spoken to, their remarks were “its alright”. Some service users were not able or willing to talk with the inspector. Some service users seemed disinterested and unenthusiastic. A few staff (nursing and support) were spoken to. They expressed concern over the increasing needs of service users in relation to staffing levels, explaining that when only one support worker was in the dining room for instance, and two or more service users called for assistance, they could not St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 16 assist. Some service users who could not wait would get up and try to assist themselves when they could not. The nurse was not always able to assist, since the nurse would be busy with paper work. Service users’ interests and welfare could be at risk. This was an unannounced inspection and the manager was not available. The deputy manager produced the staffing rota which meets the minimum guidelines. Staff also indicated that they felt excluded from the company and would welcome a visit from senior management at Head Office. A recommendation has been made. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 17 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 13 Good Practice Recommendations It is good practice when gaining service views through Quality Assurance, to audit such views to ensure service users have stimulation and have sufficient interesting occupation and events. This is to meet the standard that service users have a good quality of life. It is good practice to ensure communications systems are effective. • When the Registered Manager is away from the home, although not accountable to staff, it would be useful for Person(s) in charge to know the particular whereabouts of the manager so that in the event of an emergency, the nearest senior manager may be contacted first. Also, it gives an unprofessional image when staff say “I don’t know” (where the manager is), or guess where the manager is. • On the day of inspection when both the Registered Manager and the Administrator (and the Deputy) DS0000010329.V252583.R01.S.doc Version 5.0 Page 19 2 29 St Anne`s Nursing Home 3 33 were away, staff were therefore unaware the ground floor was unattended. This meant that staff unwittingly created an unsafe environment for service users and staff when they assumed the administrator was in to meet visitors by releasing the lock on the front door. This recommendation is similar to the recommendation relating to 13. A review of service users’ needs and audit could be undertaken to ascertain whether service users’ needs, especially in relation to staffing levels, are adequate. Alternatively, whether staff are being effectively deployed to work as a team. It is good practice to have team building exercises so that staff may also have an opportunity to express their concerns in a safe environment and not feel by such expression their only alternative is to terminate their employment. St Anne`s Nursing Home DS0000010329.V252583.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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