Inspection on 30/11/07 for St Anne`s Nursing Home

This inspection was carried out on 30th November 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 12/07/07

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 30th November 2007 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.V355328.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.V355328.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 sharon.blackwell@anchor.org Anchor Trust Vacant post 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.V355328.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 Date of last inspection 12th July 2007 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.V355328.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection to take place at St Anne’s. It took place on an unannounced basis on a week from mid morning to early evening. This inspection focused on the key standards, which had not been met at the last visit, and in particular the progress of the improvement plan sent to the Commission for Social Care Inspection (CSCI) following Anchor Trusts’ in response to the requirements in the last report. Since the last inspection 0n 12 July 2007, the Commission has been made aware of two complaints, one raised by Social Services and another by a family about the lack of care their relative received whilst in the home. Whilst these were not the purpose of this key inspection to investigate the actual concerns however the concerns raised have been considered when assessing the relevant National Minimum Standards. Islington Primary Care Trust and Local Authority have investigated these concerns under their protection of vulnerable procedures and complaints procedure. The outcomes and recommendations from those investigations have been reflected in this report. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the improvement plan. 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 and staff. To date only three relative surveys have been returned. Their comments are reflected throughout the main body of the report. During the visit we looked at a large sample of rooms throughout the premises. 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 day. Staff were observed going about their duties and interacting with residents. The inspector observed a handover in the ground floor meeting room. Four 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 there was discussion with staff and the management team about aspects of care, staffing levels, supervision, complaints and adult protection. Reports from visiting specialists were also looked at and comments are reflected throughout the report. What the service does well: St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 6 The staff at St Anne’s continue to offer a pleasant and comfortable environment for people who are referred to and live in the care home. People who live in the home still confirm that they are satisfied with the service they get. They find staff to be “kind”, “willing to help” and “good natured”. Activities are identified as a key area for praise although there is still some work to do to make sure that residents have individual activities of their choice. Staff have been described as “having an enthusiastic attitude towards learning”. The management team are clear about the strengths of the service and the areas for improvement. The home has worked hard to address the areas in the improvement plan. What has improved since the last inspection? What they could do better: The outcome of the complaints is that staff need to ensure that the changing health care needs of people living in the home are addressed promptly. The service will be receiving support from the Community Matron. The acting has yet to complete what is a lengthy task of assessing the nurses’ competencies St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 7 but this is ongoing. The home needs to address the staffs’ knowledge and understanding of cross infections procedures. 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.V355328.R01.S.doc Version 5.2 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 St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into St Annes’ are having their immediate care needs assessed prior to admission EVIDENCE: At the time of the last inspection the care home was only admitting people for respite care whilst concerns about the quality and safety of nursing care was being investigated as the result of a complaint by a relative. This embargo was lifted on 18th September 2007 resulting in the service being eligible to accept residents on a permanent basis. Four care records were looked at including a person recently admitted for respite care. Where possible the inspector spoke to the residents and their relatives about the service. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 10 All four care records contained full care needs assessments and supplementary information provided by care managers and other health and social care professionals. People said that they had been supported during the admission process and had not felt overwhelmed. One comment was “This is the better of the homes that I have stayed in.” St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear improvement in the way that staff are addressing the care needs of residents in a more personalised way. However systems are in place to make sure that staff are being vigilant when monitoring residents and assessing deteriorating health care needs EVIDENCE: The service has been subject to two complaints regarding the quality and safety of nursing practice since the last inspection. Both complaints have been based on a failure by nursing staff to recognise an overall picture of deterioration in residents’ condition and lack of a medical assessment. Residents and family members were asked if they felt the care home met the needs of their relative. Responses received were as follows: “Sometime me or other members of our family have to remind staff of my father’s needs” St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 12 “Some staff say they can do tasks and others say that can’t. So it is sometimes hit or miss.” “This depends on the staff on duty i.e. regular (long term) carers and nurse (yes they meet the needs). These comments are balanced by the following sentiments expressed by relatives in a recent thank you card (04.11.07): “I would like to thank all the members of staff who kindly cared for and comforted our dad and Granddad, in the last months of his life. A sincere thank you to all the staff, your hard work and many kindnesses are much appreciated.” An action plan had been devised in response to the first complaint investigation and this inspection focused on the progress and effectiveness of that action plan. As part of the improvement plan the staff have attended training on person centred care. This approach has highlighted and promoted the need for individualised care planning rather than generic. Allied to this, the service have undertaken a ten week Dignity Challenge Audit. The audit consists of three aspects, auditing policies and good practice guides to see if staff have read and understood them; auditing training to identify if it has been effective and underpins practice and observation and discussion. Staff to reflect on what is good practice and address practice that is considered to be poor. There are monitoring systems in place not only from the management within the home but by a specialist visitor. A sample of four care plans and the previous four weeks daily records were looked at. These were across all units and covered a range of health, personal care, and social needs. These included needs specific to racial origin, risk of pressure sores, recent admissions, visual impairment and dementia. In each case we met the person concerned, but in some instances were not able to discuss their care with them. We did, however, compare the care as detailed in the care plan with the care being received on a day-to-day basis. An inspection of care records identified that the training and dignity challenge are beginning to have an impact on the content on some of the care plans. Each individual has a care plan but the practice of involving the people who use the service in the development and review of the plan is variable. However for two people, who were case tracked, there was am improvement in the quality of the recording. The care was more personalised and it reflected the abilities of the person concerned and the level of intervention required by staff to support the person to have as independent and as fulfilling life as possible. Past life history was recorded, likes and dislikes included and end of life decisions were clear and reflected the person’s religious beliefs. Risk assessments were in place and manual handling instructions had been reviewed and updated. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 13 The remaining care plans looked at were clearly written so as to deliver the person’s care but were not detailed or person centred. Although a review of the care plan had been documented, it was not clear where the care plan had been updated as a result of a change in need. In another record there were gaps in recording on a fluid balance chart. The record implied that the person had only taken 250 mls of fluids from 17.00 to 07.00 the next morning. This has implications for someone assessed as having recurrent urinary tract infections. Two previous complaints have identified the strained relationship between the service and the GP surgery as contributing factors to the failure to react appropriately to the deteriorating condition of two service users. Feedback from staff confirmed that there is improving communication with the GP surgery. In order to ensure that staff are addressing health issues, handovers between shifts have been restructured. Both nurses and care staff attend handovers together in the large meeting room on the ground floor. All pertinent issues are discussed and the acting manager asking questions to ascertain what actions have been taken with reminders to clearly document their evidence. This format has a developmental approach for both nurses and care staff as care staff are expected to make a major contribution to the feedback. Previous to this inspection the service has received two inspections from a CSCI Pharmacist in response to medication errors. The last inspection on 11th July 2007 identified 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 monthly reports sent in by a company representative also recorded that medication administration and practices had been looked at and the overall improvements had been maintained. For this reason we only did a small audit of the management of medication and assessed that this standard was being met. The dignity audit and person centred training is having a beneficial effect on the quality of care provided by the home. Discussions with residents and staff and from observation, it is clear that some staff are using a more person centred approach. In one of the units there was increased levels of communication were, incidents of well-being were higher and staff were not excluding residents but interacting with all of them. Although one resident, with visual impairment, did confirm that some staff still do not make themselves known when entering the room, they generally felt satisfied with the quality of the care being received. Feedback from the visiting specialist has also been positive and identified areas of improvement and included comments that “The training went well with staff having an enthusiastic attitude towards learning in the session.” St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 14 In order to support staff in their development the service has arranged for specialist input e.g. Continence Advisor, Dementia Care Specialist and Community Matron. Allied to this all nursing staff will be having their competencies assessed. This process had already begun prior to the inspection. The care home has also signed up to the Gold Framework standards for the care of people who are dying and this is linked into the Palliative Care initiative. End of life decisions are being recorded and reflect the person’s religious and cultural beliefs. St Anne`s Nursing Home DS0000010329.V355328.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): Standard 12 & 14 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Projects are being implemented to enable staff to address the shortfalls in this outcome area and for managers to monitor the quality of the service delivery. It is planned that all people living in the care home will be supported to follow their chosen lifestyle. EVIDENCE: Care plans were inspected and people living in the service were asked about how they organised their day. The activity organiser was interviewed and feedback was received through surveys and from the reports by the specialist visitor. A comment was received from a relative about what the home did well, which was, “Activities – excellent. Great for the residents. Always something special arranged for their birthdays and Christmas”. The previous inspection in July 2007 identified that although during the site visit the activities were evident because of the presence of the organiser, there was not much interaction between the residents and staff who were not attending the bingo session. This was also St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 16 observed by the Specialist in Dementia Care during a monitoring visit. “ Although one lounge was very busy and the activities organiser with residents playing a game, other lounges very quiet and residents sitting not very active or communicating with each other.” This was an area to be fed into the staff training on person centred care. Discussion with the Activities Organiser highlighted that activities, motivation and stimulation is not just her province but the support and input from care staff is welcomed and necessary. There had been four sessions on person centred care and planning and some impact was noted on this visit. The training, changes to work patterns and staff deployment have encouraged more positive interaction between residents and staff. An outcome of this can be seen by the individual name plates on the doors to resident’s rooms. Each individual, who wishes, has a personalised name and picture on their bedroom door. The pictures chosen have special significance for the individual resident. Both staff and residents said that the project had promoted a lot of working together and consultation in order to get the right choice. A new ten week Dignity Challenge Audit has been implemented. The process consists of three aspects, (i) auditing policies and good practice guides to confirm that staff have read and understood them. (ii) auditing training by looking at what training had been received, on what topics, and whether further training is required, (iii) observation and discussion, staff observing good practice and practice that needs to be addressed and putting an action plan into place. The home will only be able to register as “Dignity Champions” when the audits and action plans have been completed. This exercise along with the person centred training will provide the systems for checking practice that have been absent. It will enable staff to reflect on their practice and ensure that people living in the care home have access to a flexible lifestyle where their choice of routine and activity will be routinely met. Feedback from relatives was that there had been no hairdressing service for several weeks in the home. Discussions with the management team confirmed this. The current hairdresser had surgery and needed to recuperate. The home was unable to find a hairdresser with a Criminal Records Bureau check and it would have been a lengthy process to apply for one. Although the management team had identified another hairdresser from another home, when approached the residents preferred to wait for the hairdresser they knew and trusted. St Anne`s Nursing Home DS0000010329.V355328.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): Standard 16 & 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the service are protected by the homes’ policies and procedures relating to safeguarding adults EVIDENCE: The last inspection report recorded that the home was subject to an investigation following concerns by a relative. An independent person from the Islington Primary Care Trust was investigating the complaint.. Since then the home has received two further complaints regarding the quality and safety of nursing care in the home. Both of these have been looked at by external investigators and recommendations made. The home notified the Commission for Social Care Inspection of the last complaint and will forward the report to us. The management team have attended meetings and provided information to the external agencies when requested. Feedback from relatives confirmed that they knew how to make a complaint. The action plan recorded that every new admission would be given a copy of the complaint’s policy with details of how to make a complaint. Confirmation was received from one of the people on respite care. That they had received a copy of the complaints procedure and a staff member had taken the time to explain it . Feedback from residents confirmed that they felt comfortable about approaching the staff and/or the manager if they were unhappy. One resident gave a clear example of approaching the management team because there had been no chiropody service. This had since been organised and the St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 18 chiropodist had attended. Staff were observed listening to people’s concerns and managing them appropriately. Complaints continue to be logged and records show that investigations are carried out and remedial action taken where it is indicated. Discussions with staff showed that they are familiar with the adult protection procedure and confident to report any untoward incidents. They clearly understood the concept of adult abuse and reporting arrangements. St Anne`s Nursing Home DS0000010329.V355328.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): Standard 26 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff practices are potentially placing people living in the home at risk by not following the prevention of cross infection procedures. EVIDENCE: A relative had returned a survey, which commented that “the standard of cleaning had gone down in the last year”. This was an area that had also been picked on during an infection control audit on 21st November 2007. This was the first audit undertaken in the home by a Care Specialist from Anchor Trust. The report makes reference to dusty surfaces, kitchen fans, skirting boards and stairs needing thorough cleaning and cobwebs in the first floor lounge. On the day of the inspection visit, which was unannounced, the communal areas looked clean and tidy. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 20 Although areas of good practice had been identified during the visit amongst some staff, the report recorded incidents which showed that not all staff understood or complied with prevention of cross infection procedures. Overall through out the visit “hand hygiene was considered very lax in between intervention and activities” Staff relied on gloves as a preventative measure and felt that hand washing was less important. An example was cited in the report where a member of staff wearing gloves to collect linen from a resident with MRSA, but continued to wear the same gloves throughout the whole process of collecting laundry. The report identifies that because of the lack of storage in residents’ ensuites residents can potentially be at risk because creams and lotions are stored on cisterns. The report has identified that there is still a significant amount of work to do in this area. A requirement has been made. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 21 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): Standard 28 & 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Evidence suggests that there is still evidence of inconsistency in the skills and knowledge base of some staff however training, development and specialist support will ensure an improved service delivery. EVIDENCE: A comment from a relative was “Changing regular carers is not good for the residents. They get to know these carers and develop a relationship with them. My mother feels comfortable and at ease with them which is important to her.” There have been changing to working practices and how staff are deployed. The management team have taken account of the needs and routines of people using the service . A new system of extra staff on certain units has been introduced. Staff have confirmed that this has been beneficial as it gives them more time to spend with the residents. With the advent of person centred working then relationships between residents and staff can be quickly built up. Feedback from people living in the care home is that they are generally satisfied with the care they receive. They describe staff as “very kind”, “friendly and caring” and “they do a good job” Previous comments recorded in earlier sections of this report reflect that some staff are confident and knowledgeable in their work whilst others are not. Comments such as: St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 22 “Sometimes me or other members of our family have to remind staff of my father’s needs” “Some staff say they can do tasks and others say that can’t. So it is sometimes hit or miss.” “This depends on the staff on duty i.e. regular (long term) carers and nurse (yes they meet the needs). Visiting professionals have also identified that there are good working practices amongst some staff whilst others need further training and development. Although the care home does have recorded that 90 of care staff have an NVQ accreditation. The home has been the subject of three investigations in to the safety and quality of care for three individual service users and it has been identified that nursing staff have not responded appropriately to the deterioration of service users with complex needs. In order to ensure that all staff are working at an improved level a training plan has been introduced. Records show that staff are attending training sessions and monitoring systems are in place to identify progress. This is being done on an individual basis through supervision and collectively during handover. Weekly study groups have been introduced. A programme of measuring nurses’ competencies has been introduced and due to be completed by 15th January 2008. Research of written work is to be evidenced based. Specialist advisors have been engaged including 6 months support from a community matron. Generally feedback from one of the specialist advisors is that “staff have an enthusiastic attitude towards learning”. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 36 & 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress has been made to make sure that a review of staff competencies and management systems is taking place so that the service is `managed in the best interests of the people who live in the home. EVIDENCE: Since the last inspection the registered manager is no longer in employment. Anchor Trust have been recruiting for a new manager and a likely appointment has been made following recent interviews. It is anticipated that the new start date will be early in the New Year. In the mean time there are interim management arrangements in place consisting of a recently recruited deputy manager and acting manager. This arrangement can be effective until March 2008. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 24 There has been a mixed response regarding the change in management style from visitors to the home. One relative commented that they had been experiencing a number of problems with the current management arrangements, finding then “unapproachable”; whereas another comment described the deputy as “very person centred, enthusiastic, experienced and observant.” On the whole feedback from visiting professionals has confirmed that the change of management style has brought about an improved culture and atmosphere in the home. The management team recognise the need to support staff in training and development in order to improve service delivery. Comments from a social care professional confirmed that “It is felt that there was a genuine desire to try to improve service delivery.” Systems have been put in place such as structured handovers, weekly study groups, measuring nursing competency and engaging specialist advisors that enables the management team to monitor practice and compliance with the plans policies and procedures of the home. The management team have clearly expressed that this work is ongoing. One area identified is that “no attempt has been made to meet family/relatives. This has a big effect on the care the residents are getting as there is no supervision; never a manager seen on the floors.” The deputy manager is taking the lead in respect of the improvement plan for the home and the other initiatives within the home. Feedback from the management team are that “residents meetings are taking place monthly, where residents are invited to have their say and raise issues of concern. Minutes of these meetings are available on request.” The frequency of relatives’ meetings are to be increased to be held on a quarterly basis. It is planned for the new manager to have a weekly surgery starting in February 2008, where relatives will be invited to discuss any issues of concern. Supervision is taking place on an individual basis as well as a group basis during the new structured handover and through the Dignity Challenge, Person Centred Care Training and the Gold Framework Standard. However as part of the consultation process care then the management team should arrange residents and relatives meetings at regular intervals to get feedback from both residents and relatives. A sample of health and safety records were looked at and found to be up-todate and accurate. However a requirement has been set regarding the arrangements in the home for prevention of cross infection as discussed in the comments under the environment section. St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 25 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 2 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 1 STAFFING Standard No Score 27 X 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 2 St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 26 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 Provider must ensure that the changing health care needs of people living in the home are addressed promptly. The Registered Provider must submit a monthly report to the Commission For Social Care Inspection of the type of support received from the Community Matron identifying areas of weakness and what staff have learned from the input. This requirement is being restated from the inspection 12th July 2007 The Registered Provider must make sure that staff are implementing current cross infection procedures. The Registered Provider must address the issues raised in the Infection Control Audit dated 21st November 2007 This requirement is being restated from the inspection 12th July 2007 St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 27 Timescale for action 31/01/08 2. OP26 OP38 16(j) 29/02/08 3. OP30 18(1)(a) The Registered Provider must make sure that staff are competent to meet the assessed and changing needs of the people living in the care home. When the outcome of the qualified staffs’ competencies are known the Registered Provider must submit a development plan identifying the shortfalls and the action to be taken to address any areas of weakness. This requirement is being restated from the inspection 12th July 2007 The Registered Provider must confirm in writing the name, qualifications and start date of the new manager as well as when an application for registration is submitted. 31/01/08 4. OP31 9(a)(b)(i) 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Anne`s Nursing Home DS0000010329.V355328.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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.V355328.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!