Inspection on 16/05/08 for St Anne`s Residential Home

This inspection was carried out on 16th May 2008.

CSCI found this care home to be providing an Poor service.

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 Residential Home 17/05/07

St Anne`s Residential Home 20/11/06

St Anne`s Residential Home 15/11/05

St Anne`s Residential Home 22/06/05

St Anne`s Residential Home 18/01/05

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Anne`s Residential Home St Anne`s Residential Home Clifton Deddington Banbury Oxfordshire OX15 0PA Lead Inspector Delia Styles Unannounced Inspection 16th May 2008 10:30 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 Residential Home DS0000062413.V363181.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 Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Anne`s Residential Home Address St Anne`s Residential Home Clifton Deddington Banbury Oxfordshire OX15 0PA 01869 338295 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) ruralcareltd@aol.com Mr Prashant Brahmbhatt Post vacant Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2007 Brief Description of the Service: St Annes care home is situated in the village of Clifton, near Deddington on the Oxford/Banbury road. The home is a few miles from the M40 and main line rail station at Banbury. The property is a period stone built cottage, which has been extended. St Annes was first registered as a care home in 1987 and is home to 22 older people who suffer from forms of memory loss, Alzheimers and other types of dementia. Accommodation is provided in 14 single and 4 double rooms on two floors. Most rooms have en-suite washbasin and toilet facilities and there is an assisted bathroom and toilet on each floor. The fees range from £490.00 to £700.00 per week and include social and recreational activities, personal laundry, hairdressing (except ‘perms’), newspapers and podiatry. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The overall quality rating is made using ‘key lines of regulatory assessment’ KLORA – and a ‘rules base approach’. This takes particular account of how safe and how well managed a care service is. As they are especially important to quality, we have stricter rules for those outcomes relating to Health and Personal care, Complaints and Protection, and Management and Administration. Services can only be as good as their poorest rating in these areas. Because we have concerns about how well the homes staff understand and follow the guidance and procedures about how to recognise and report suspected abuse of vulnerable people the outcomes for Complaints and Protection is rated ‘poor’ and this has affected the overall quality rating for the home. This inspection of the service was an unannounced ‘Key Inspection’ during which we assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. As part of all key inspections that took place in the half of May 2008 the Commission asked inspectors to look into the topic of ‘safeguarding’ of adults in more depth. Some staff and the manager were asked questions about what they know about keeping residents safe and how well the service makes sure that people are protected from abuse. Because the people who live at St Anne’s have problems with their memory, and are not always able to tell us about their experiences, the inspector did not question individual residents. The inspection visit took place over 6 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self-assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year; and any information that the Commission had received about St Anne’s since the last inspection. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Talking with a number of residents and staff gave us information about the home and peoples’ opinions about what it is like to live here. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 6 Some of the Commission’s comment cards (surveys) were left at the home for residents, staff, relatives, and visiting health and social care workers to have an opportunity to have their say about the home. Three surveys were received in time for people’s comments to be reflected in this report. We would like to thank all the residents, staff, manager and the home’s proprietor Mr Brahmbhatt, for their welcome and the time taken to help us with the inspection process. Please note that reference is made to ‘the manager’ throughout this report. This refers to the person appointed by the registered person (Mr Brahmbhatt) to manage the home in the absence of a registered manager. All registered residential care homes and other ‘establishments’- for example, nurses’ agencies and domiciliary care agencies - are required by law to be run by a registered manager – that is, someone who has applied to the Commission and has been assessed and approved by the Commission as a ‘fit person’ What the service does well: What has improved since the last inspection? The home has replaced carpets in the main sitting room and residents’ bedrooms and provided new armchairs. A new call bell system has been installed and automatic room door closers fitted to improve the safety measures in the home. The en-suite facilities in bedrooms have been upgraded to make them more suitable for residents’ use. Several new beds have been purchased for the comfort of more disabled residents. The home has taken action to improve the storage areas for laundry and introduced better infection control measures, such as protective hand gel for visitors and staff when entering and leaving the home. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 7 The AQAA tells us that the menus and the way in which food is presented have been improved, with better meal choices for residents and to encourage those with poor appetites to eat a nourishing diet. There is now a structured training programme for staff and more staff have completed or started the recommended National Vocational Qualification (NVQ) training courses. Better-trained staff should result in staff having a better understanding of the care needs of the residents and have a positive effect on the standard of care and support. The home has increased the number of staff, especially in the mornings, so that residents have improved care and attention. What they could do better: Some good practice recommendations are made about further improving residents’ care records - for example, as part of the regular review of people’s care records, writing about whether the care given by the staff matches what was agreed in their care plans and if not, what changes will be made. We found that an allegation of poor care and abuse made to the home in January 2008 was not reported to the Local Authority Adult Safeguarding Team or to the Commission as required. The home must let us know about ‘any allegation of misconduct by the registered person or any person who works at the care home’ (Regulation 37 of the Care Homes Regulations 2001). The registered provider has failed to meet a requirement made at the last two inspections: Regulation 26 of the Care Homes Regulations 2001 states that the proprietor (or one of the directors or other persons responsible for the management of the organisation) must make unannounced monthly visits to the home to inspect the premises, talk to residents, visitors and staff to get their views about the standard of care, and to write a report about how the home is managed. Repeated failure to meet legal requirements within the times scales given may lead to us taking enforcement action against the provider. The home has been without a registered manager since December 2006. The registered person, Mr Brahmbhatt, must appoint a person to manage the home who will be registered (under Part 11 of the Care Standards Act 2000) and legally accountable (together with the registered person) for maintaining the standards of care and facilities for the people living here. Two further good practice recommendations are made about the safe storage of cleaning products and denture cleaning tablets and securing electrical cables and trailing flexes to lessen the risk of trips and falls for residents. Please contact the provider for advice of actions taken in response to this St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 8 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 Residential Home DS0000062413.V363181.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 Residential Home DS0000062413.V363181.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): 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. The process for the pre-admission assessment of potential residents is satisfactory and the home has plans for further improvements to the documentation to show how they will meet the individualised ‘person-centred’ care and support of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the home – the Statement of Purpose and Service User’s (Resident’s) Guide – is not up to date. The manager said that these documents will be reviewed and updated and that there are plans to make the Service User Guide information more accessible for residents to read and understand. A copy of the home’s most recent CSCI inspection report (which should be available as part of the Service User’s Guide) was not available in the home and staff said they were not aware of it. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 11 The home should make the intended changes to the written information about the home so that people have up to date and accurate information as part of the process to help them decide whether or not the home is suitable for them. The manager undertakes assessment of prospective residents’ needs before they come into the home. The home plans to improve the paperwork they currently use so that the assessment information covers all aspects of people’s needs in a more ‘person-centred’ way. Written comments in a staff member’s survey, and concerns voiced by a staff member in a phone call to the inspector, indicate that staff do not always feel confident that they can meet the assessed needs of residents, especially those residents who may be ‘challenging’ and aggressive because of their dementia. The assessment includes information from local social services or the prospective resident’s current family or professional carers, and the individual themselves, where able. All new residents have a ‘trial’ four week settling in period during which further assessment and discussions can take place so that the individual, their family and/or representatives and the home staff can be sure that the person’s assessed needs can be met. St Anne`s Residential Home DS0000062413.V363181.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 and 10 Quality in this outcome area is adequate. The homes policies and procedures and staff training provide staff with an overall understanding of the needs of the residents living here. Although improving, there is variable practice regarding the delivery of personal care so that the residents do not always have a consistent standard of care and support from staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The plans of care for 3 residents were inspected. Care plans consist of a care plan diary and individual support plan. The various sections - ‘What matters to me’, ‘This matters to me’ and ‘Support I need to make this happen’ – set out very clearly peoples’ preferences about the way they wish to be looked after and supported. The AQAA tells us that senior staff review and update each person’s support plans at least monthly. As part of the review the staff, (and resident and their family member where possible) meet to discuss any changes and adapt the plans as necessary. The records could be further improved to include some ‘evaluation’ comments to show to what extent residents and/or their St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 13 representatives are satisfied with the care and support and that it still matches their support plans. Since the last inspection in May 2007, we have received (August 2007) concerns from an anonymous staff member alleging deteriorating standards of personal care and poor moving and handling techniques used by some staff and these were referred to Mr Brahmbhatt to investigate and follow up at the time. Similar concerns were raised with the inspector during this inspection by a staff member and by another employee some days after the visit. The home does have mobile hoists (one on each floor) for staff to assist residents and the AQAA states that the stair lift (there is no passenger lift in the home) is to be upgraded so that residents can be transferred onto it by hoist. (See also – Staffing and training). The AQAA also shows us that a high proportion of the people who live here are now much more dependent on staff help, because of their deteriorating physical and mental health. A number of residents have visits from the community nurse. We recommend that the homes care plans for residents include reference to any treatment or advice given by the district nurses (the district nurses keep their own records in the homes treatment room) so that all the homes care staff are kept up to date with any new information and care instructions about the residents. The medication administration records (MAR) were looked at, and the storage arrangements for medicines in the home. Residents’ tablets are provided in pre-filled packs from a high-street chemist. Discussion with a member of staff on duty who is authorised to give out medications (the ‘key-holder’) and checking the MAR sheets it was evident that the home operates a safe and secure system so that residents receive their prescribed medicines. However, it was found that the home was not storing one medication correctly. ‘Temazepam’ (a night sedation) must be stored separately from other prescribed medicines in a Controlled Drug (CD) cupboard that meets the legal standards for storage. The manager was informed about this at the inspection and promptly took action to correct this. The manager confirmed that the pharmacist regularly visits to check that everything is in order and she also undertakes internal checks as part of the homes quality assurance checks. During the inspection it was seen that residents were spoken to respectfully and kindly by staff and that staff knocked on room doors and asked residents’ permission before going into their rooms. Shared rooms have curtain screens to maintain the privacy of residents when personal care is being carried out. Staff were noted to intervene and tactfully distract residents who were becoming argumentative with each other. Several residents prefer to remain in their own rooms during the day and their right to privacy is respected. Staff make sure that they make regular checks on people who are in their rooms so that they do not become isolated. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is adequate. There is a limited range of activities within the home and community so that not all residents have the opportunity to take part in activities and social interaction that meets their individual needs and abilities. Because of the small dining area and the reliance of most residents for staff help at mealtimes, the social aspect of mealtimes is limited. Progress has been made in the choices if menu and presentation of meals. The manager has a good understanding of the areas of weakness and how the service can be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From reading residents’ support plans and observing with residents it was clear that most staff are knowledgeable about residents’ individual preferences about how they spend their day and they are encouraged to make decisions and choices about what they do as far as possible. The home has an activities organiser who works part-time on weekdays in the home and who plans and organises group activities and social events for residents. Information about planned activities and events are displayed in the home. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 15 Staff said they do try to occupy and chat to residents throughout the day. However, an observation made on the day of the visit was that residents appeared to be sitting in the ‘cathedral room’ and sitting area by the reception area, or in their rooms with nothing to do. The AQAA shows us that the home is aware of the need to provide different activities and experiences for those residents who are now very frail and disabled by their dementia. They plan to increase the opportunities for one to one activities with residents who are unable, or do not wish to join in larger groups. Since the last inspection and recommendations made, the home has introduced an ‘Activities audit’ – an activities book is completed by the activities person who notes residents’ comments and gives feedback about how people have enjoyed the various organised entertainments. The resident who had completed our survey (with the help of a carer) commented that though there are ‘usually’ activities arranged by the home they are unable to take part ‘as I can not walk down the stairs and do not like the chair lift. Staff do come and sit with me sometimes’. The home now has a pet rabbit (with a hutch and run in the garden) an added attraction for those residents able to access the grounds. The home has reviewed the meals and menus to provide a wider choice. As at the last inspection, one choice of main course and dessert was written on the menu board in the dining area at lunchtime. However we are told that alternatives are always available for residents who may change their mind about what they want to eat. The main course (fish) was nicely presented and for those people who need soft or pureed food, the different foods were separately pureed on the plate and the fish was served in a sauce. It was noted that hot food both at lunchtime and supper was served to residents on plates that were barely warm. Meals are individually plated up in the kitchen and then taken (covered) on an unheated trolley to the dining area ready for service to residents. Staff confirmed that 11 (out of a total of 19) residents need full assistance with their meals and others need supervision or prompting. This means that, with only 5 care staff available, there is a risk that residents’ meals will become cold and less palatable because they have to wait for assistance. The home should look at the timing and management of mealtimes to ensure that everyone is able to eat at their own pace and that hot and cold foods are served and kept at adequate temperatures. The dining area is small – a wide corridor – with individual tables set for two people in a row along one wall. Because of the limited communal dining space, most residents take their meals in the ‘cathedral’ room, small sitting area (the ‘library’ room) or in their rooms. In the inspector’s opinion this means that the social opportunities (for conversation and eating together) at mealtimes are St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 16 more difficult to achieve. The proprietor said that planning permission has been given for a new extension to be built and when completed, will provide improved dining room facilities for residents. St Anne`s Residential Home DS0000062413.V363181.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): 16 and 18 Quality in this outcome area is poor. The home has a satisfactory complaints system with some evidence that the family and representatives of the people who live here feel that any concerns are listened to and acted upon. All staff have had training around safeguarding adults but some have a limited understanding in this important area. This leads to inconsistent knowledge and practice within the service. Failure by the registered person to report a safeguarding issue to the Local Authority and the Commission is a further indication that the safety and protection of residents may be compromised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA tells us that since the last inspection, the homes complaints procedure has been sent to all residents’ families and has been displayed more prominently in the home. Five complaints had been received by the home in the previous 12 months (April 2007 – April 2008), one of which had been upheld. The home plans to improve the way it supports residents living with dementia to raise any concerns or complaints. The homes record of concerns and complaints showed that the home had investigated and responded to complainants appropriately and within the timescales set out in its procedures. The Commission has received information concerning 3 allegations made against the service since the last inspection and judges that the registered person has not met the regulations in relation to complaints and safeguarding St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 18 During this inspection a staff member told us about allegations of abuse that they had brought to the attention of the manager and registered person (the proprietor) under the ‘whistle-blowing’ procedure in January 2008. The staff member considers that their concerns were not properly addressed and that the proprietor did not take the appropriate action. The proprietor did not report the alleged abuse to Oxfordshire Social and Community Services under the Adult Protection/Safeguarding Adults Procedures. Nor did he notify the Commission as required under the terms of Regulation 37 (‘the registered person shall give notice to the Commission without delay of the occurrence of …any allegation of misconduct by the registered person or any person who works at the care home’). The homes own complaint record did not include the allegation/complaint made by the staff member as required (Regulation 17(2) Schedule 4 of the Care Homes Regulations 2001). The outcomes of the registered person’s investigation into the alleged abuse and the outcomes, were not formally recorded: handwritten notes of meetings held with individual staff and the proprietor (taken down by the manager who was present), and handwritten statements from the two staff concerned, were shown to the inspector by the manager during the inspection. We consider that the registered person has failed in his duty of care and responsibility for the welfare of residents on this occasion by not following safeguarding procedures and he did not support or instruct the manager to do so. As part of all key inspections that took place in the half of May 2008 the Commission asked inspectors to look into the topic of ‘safeguarding’ of adults in more depth. Some staff and the manager were asked questions about what they know about keeping residents safe and how well the service makes sure that people are protected from abuse. Because the people who live at St Anne’s have problems with their memory, and are not always able to tell us about their experiences, the inspector did not question individual residents. Two of the three staff asked about their understanding of how to report any suspected abuse were unclear about what they should do. One staff member questioned had a very limited understanding of spoken English – this individual did not appear to understand the questions or the examples given to explain what is meant by ‘abuse’, nor could they give satisfactory answers that would indicate what they would know what to do if they suspected or witnessed abuse. The staff files seen showed that staff have attended Adult Protection/Safeguarding training. A flow chart about the Safeguarding St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 19 procedure was clearly displayed in the front reception area of the home and all new staff are given the General Social Care Council codes of conduct for social care workers and employers that describe the responsibilities of staff to report concerns about poor care or conduct that may harm vulnerable people. The only staff survey we received answered ‘yes’ to the question ‘Do you know what to do if a service user/relative/ advocate or friend has concerns about the home’. The resident who completed our survey stated that they would ‘tell the carers who came into my room’ if they had a complaint to make. Since the last inspection the manager has attended an advanced training course in Safeguarding issues led by the Local Authority though this was aimed more at the Local Authority staff and how they investigate reported abuse. She intends to attend the Level 2 course (more appropriate for managers or professionals working with adults at risk of abuse). We recommend that the home provides more discussion about the practical issues about safeguarding to improve staff understanding about their responsibilities to recognise and report suspected abuse and poor care. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 20 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): 19, 21, 25 and 26 Quality in this outcome area is adequate. There is an ongoing programme of refurbishment and redecoration that means that residents live in a clean and comfortable environment. The home has plans to improve and extend the building and facilities for the benefit of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is not purpose built but has been altered and had additions made to accommodate twenty-two residents in the 18 bedrooms. The original building at the front of the property is in keeping with the other buildings in the village and has many original features associated with the period that it was built. To the rear of the property is a two-storey extension that provides bedrooms with en–suite facilities and the larger of the two communal lounges. The home has two assisted bathrooms, one on the ground floor and one the first floor. The first floor is accessible via three separate flights of stairs and for the less able, a stair lift. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 21 The home environment has been further improved since our last inspection. The AQAA tells us that the lounge and bedrooms have been re-carpeted, new armchairs provided for residents and a new call bell system installed. Most of the en-suite shower trays have been taken out of residents’ rooms and the ensuites upgraded with toilets and washbasins more appropriate for residents needs. All internal room doors have been fitted with automatic closer devices: this allows residents to have their room door open if they wish but the door will automatically close in the event of a fire, to protect them from smoke and flames. A survey response from a visiting health care professional included the observation that ‘the costly areas of improvement are in hand and the facilities are gradually improving for the patients’ It was noted that the home was clean and tidy throughout and largely free of any unpleasant odours. The home has bought a new carpet shampooer machine that has helped in the maintenance and prompt cleaning of the carpets. A check of the hot water temperatures at the bath taps showed that the water (early afternoon) was tepid. Staff record the temperature of the water before bathing residents, which is a good practice safety precaution. The temperatures recorded showed that the water temperature is often below that recommended as a safe and comfortable temperature for residents – which should be close to 43ºC. Some staff have told us that there are often problems with the hot water supply and this affects their ability to meet the hygiene needs of residents. We were told that on the morning of the inspection the hot water temperature had been 34ºC – too cold to wash residents. The first floor bathroom has been upgraded to make it more accessible for dependent residents. In practice the inspector was told that this bathroom is not often used – residents are taken to the ground floor assisted bathroom. The ground floor bathroom is scheduled to have a complete refurbishment. We have also received information that there are frequently problems with the oil fired central heating system so that residents feel cold. However, a staff member accompanying the inspector said there was not a problem with the heating and Mr Brahmbatt, the proprietor, also confirmed this. The AQAA states that the homes plans for improvement in the next 12 months are to install solar panels for heating and hot water in the home. On the day of the inspection one resident in a first floor room complained of feeling cold, though this may have been because she was sitting by an open window (the room radiator was on and felt warm to the touch). A ground floor room near the kitchen felt cold, and again a resident was sitting with an open St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 22 window behind he in this room. Additional blankets were seen in several bedrooms. Free standing electric tower convector fans were seen in some residents’ rooms - the weather had recently been very warm, but at the time of the inspection was much cooler, so the fans were not needed. The external parts of the home and its grounds are kept secure by a locked gated entrance and an enclosed garden area. The area used for waste bins near the front gate has been screened off since the last inspection, so that it is tidy and does not spoil the appearance of the home at the front approach. No structural changes have been made to the laundry facilities that are housed in an old stone outbuilding that has a rough unsealed floor and wall surfaces that are difficult to keep clean. There are large gaps around the doorframe and the under the door, so that vermin could get in. The proprietor said that the proposed new building would include a new laundry facility to replace the existing one. The open shelving used for storage of incontinence pads, cleaning and laundry chemicals has been improved as recommended at the last inspection with the addition of cupboard doors. The laundry machinery and processes are in line with recommended hygiene and infection control measures. Improvements have also been made to the storage of clean linen in the house by adding doors to the open shelving. New laundry bags and a trolley have been provided to reduce the risk of infection and injury for staff moving and handling laundry loads. The home only launders residents’ personal clothing - all bedding and household linens are sent to a commercial laundry service. The home employs someone to do the laundry work and to do some cleaning in the house, in addition to the two housekeepers. All staff have had training in infection control measures for the protection of residents and visitors. There is a protective hand gel dispenser for the use of visitors and staff entering and leaving the building and adequate hand hygiene equipment and disposable gloves for staff use throughout the home. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. The staffing numbers and skills of staff have improved since the last inspection but staff turnover and difficulties in recruiting suitable new staff has slowed the progress made in training and development of the staff team. The care and support needs of residents are not always consistently met because not all staff are competent to do their jobs. The home has plans to improve the training programme and the capacity to improve should result in better outcomes for the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota for the period 26th May to 8th June 2008 was reviewed to assess the number of staff available for direct care of residents. This showed that it is usual for five care staff to be on duty at all times during the daytime, evening and including weekends. At night, there are always two staff on duty. There is a regular team of cooks and kitchen staff for the main meal times of the day including weekends and bank holidays. There is a senior member of staff ‘on call’ (usually the manager or registered person) overnight and at weekends to provide advice and support to staff working in the home if needed. According to the information in the AQAA (April 2008) 6 full time and 1 parttime care staff have left employment in the home in the 12 month period before April 2008. This represents a turnover of 25 of staff. The home does not use agency staff so that the homes own permanent and bank staff cover any vacant shifts for colleagues who are on holiday or off sick. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 24 It was noted that 2 care staff on the rota examined are rostered to work a mixture of nights and days in the same fortnight and that their hours of work will total approximately 50 hours a week. They have split day’s off/rest days, with only 2 or 3 days off in the fortnight. The home should review the staff work patterns to ensure that staff have adequate rest periods between shifts. If staff work long hours with insufficient rest periods between night and day shifts there is a risk that they will become overtired and this may have a detrimental effect on their health and their ability to care for residents. At the last inspection the manager was hoping to improve the ratio of skilled and experienced staff by appointing a ‘head of care’ and a Care Leader to compliment the team. These posts were filled but the staff appointed have since left the home. This means that that the manager currently has no deputy or administrative support to help her with the leadership and supervision of staff. The staff member who completed our survey wrote that ‘sometimes we are short staffed and this does have an effect on how long we can spend with an individual’. Their comments reflected concerns also raised with us by other individuals in relation to staff turnover and some staff members’ communication skills which affects the care of residents, for example: ‘staff who are really capable and good are leaving and it is upsetting to see this… Residents’ families have told us that they like to see continuity with relation to staffing. They like to see that staff have been here a long time. We lose such a lot of really experienced carers and do not know the reason for this’. ‘I think…you need to have a lot of English speaking staff. Residents already have enough disability with their Alzheimer’s, let alone trying to understand somebody who cannot speak English’. The recruitment records for four staff employed since the last inspection were examined. These were well organised and showed a thorough approach to the vetting of prospective workers to make sure that unsuitable or disqualified people are not allowed to work with the vulnerable people who live here. There is a programme of staff training in place including National Vocational Training (NVQ) in Care and induction training for all new carers that meets the required standard. Training records sampled showed that infection control, Fire Safety, Health & Safety, Adult Protection and Caring for Confusion were some of the training sessions satisfactorily completed by the new staff. We have received concerns alleging that not all staff understand or use the correct and safe moving and handling techniques to help dependent residents and this has resulted in bruising. The manager and registered person are St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 25 aware of the concerns and must ensure that all staff are trained and their work monitored to ensure that residents receive appropriate and skilled care at all times. The manager said that a senior carer has undertaken training (‘Train the Trainer’) in safe moving and handling and is qualified to show and supervise other carers the correct techniques and use of the hoists. A staff member said that she felt that training had improved for new staff. The home has done a training audit to identify the training needs for each member of staff and has access to organisations to provide a structured training and development schedule for all staff. In particular the home plans further training in caring for people whose dementia means their behaviour may be challenging, and about the Mental Capacity Act and how this supports the rights of residents to continue to make their own decisions. The home reports an increased take up of National Vocational Qualification (NVQ) training. Nine of the total of 25 care staff (21 permanent and 4 bank staff) have NVQ Level 2 or above, with a further 7 working towards NVQ qualification. This means that 50 of staff are NVQ trained or are in the process of training. The home benefits from having its own training and staff rest room – a large summerhouse in the grounds – equipped with educational and training resources. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 36 and 38. Quality in this outcome area is poor. The temporary management arrangements must be consolidated so that the home has a registered manager with adequate administrative and staff support to fulfil their role. The formal processes for supervising and monitoring of staff should be further developed to make sure that the home’s policies and procedures are understood and consistently followed for the wellbeing and safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been without a registered manager since December 2006. In the interim, the former deputy manager has taken on the responsibility for running the home with the support of the proprietor. Prior to being appointed as manager, she had been deputy manager at the home for over two years and before that had worked as a care worker and senior care worker in the home, so she has a good understanding of the home, the staff team and the St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 27 people living there. She has undertaken NVQ 4 training appropriate for the role and plans to enrol on the Registered Manager Award course – a formal qualification required for those with management responsibilities in care establishments registered with the Commission. The manager has identified that she needs administrative support and a deputy to support her in her role. At the inspection Mr Brahmbatt said that administrative help would be provided from another residential home he owns in Oxfordshire. The registered person must formalise the management arrangements of the home by ensuring that they propose a person who applies and successfully completes the ‘fit person’ process with the Commission in order to become the ‘registered manager’ for the home. It is a legal requirement that registered care homes and establishments are run by a registered manager. The AQAA tells us that Quality Assurance questionnaire forms are ‘sent out periodically to all of the residents and their families to gain opinions on the service’. The results of the most recent survey were not available in the home (as was the case at the last inspection in 2007). The National Minimum Standards(NMS) for Care Homes for Older People states ‘the results of service user surveys [should be] published and made available to current and prospective users, their representatives and other interested parties, including the NCSC’ (now the CSCI). The NMS also recommend that the home should use ‘an objective, consistently obtained and reviewed and verifiable method (preferably a professionally recognised quality assurance system) and involving service users. The manager said that in practice the outcome of the survey responses does influence and guide changes that they make in the home. As found at the last 2 inspections the manager was not able to provide evidence that Regulation 26 ‘provider’ visits have been carried out. The registered person (Mr Brahmbatt) is required to visit the home ‘unannounced’, at least every month to inspect the premises, its record of events and records of any events, and to talk to residents and any visitors, and staff in order to get view about the standard of care provided in the home. He must then ‘prepare a written report on the conduct of the home’ a copy of which must be made available to the manager and the Commission. These ‘provider visits’ are an important part of the way in which the registered person can evidence that the standard of care and facilities provided in the home is meeting residents’ needs and expectations and that any concerns are followed up and resolved. The management of personal finances for residents was discussed. Most residents’ families deal with their financial affairs. Fees include everything except some hairdressing (‘perms’) the cost of which is invoiced to residents with their fees. Small purchases made on behalf of residents are entered in a St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 28 record book and records of money and valuables in safekeeping were up to date. The programme of formal supervision of staff – a regular (at least 6 times a year) meeting between each carer and their line-manager/supervisor – had been implemented but the manager said supervision meetings had been slightly delayed recently because of senior staff changes. In response to the question in our survey, ‘Does your manager meet with you to give you support and discuss how you are working? the staff member answered ‘often’. This individual also felt that the ways that information about people who use the services is passed between staff (including the manager) ‘usually’ work well. The manager said that the company is in the process of reviewing all its policies and procedures. The AQAA lists all policies and procedures as last reviewed 12/02/07. There are good systems in place on paper for safe working practices with risk assessments in residents’ care plans for moving and handling, mobility, nutritional risk and falls. There was also information about infection control and MRSA. Some potential hazards were noted during a walk around the home – for example a bottle of bleach cleaner was left in an unlocked laundry cupboard and denture-cleaning tablets were left on a shelf in a residents’ en-suite. There is a risk that confused residents could access these products and if they swallowed them mistakenly, could cause them serious injury. These hazards were pointed out to a member of staff who promptly removed the bleach to more secure storage. Several rooms had trailing electrical wires and flexes for peoples’ air mattresses (special mattress toppers to help prevent ‘pressure ulcers’), radio/TV. and room fans. These are a potential trip hazard and should be taped or secured to reduce the risk of residents or staff tripping over them. The manager completed the AQAA. It gives a reasonable picture of the current situation within the service but more evidence and detail could have been provided about how the home still needs to improve and how this will be achieved. St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 29 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X X 2 3 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 Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 30 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 OP18 Regulation 37 (g) Requirement Notify the Commission without delay of any allegation of misconduct by any person who works at the care home. ‘The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse’ A record of all complaints made …by persons working at the care home about the operation of the care home and the action taken by the registered person in respect of any such complaint’ must be kept in the care home. The registered person must visit the home in accordance with Regulation 26 and ensure that evidence of these visits is available in the home and available for inspection. This is an outstanding requirement from two previous inspections. It is a requirement to register: ‘1) Any person who carries on or DS0000062413.V363181.R01.S.doc Timescale for action 31/07/08 2. OP18 13 (6) 31/07/08 3. OP18 17(2) and Schedule 4 (11) 31/07/08 4. OP33 26 and Schedule 4 (5) 31/07/08 5. OP31 Care Standards 31/10/08 St Anne`s Residential Home Version 5.2 Page 31 Act 2000 Section 11(1) manages an establishment or agency of any description without being registered under this Part in respect of it (as an establishment, or as the case may be, agency of that description) shall be guilty of an offence’. 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 OP7 Good Practice Recommendations Include written evaluation of the care and support provided by staff in residents’ care plans and individual support plans. Evaluation should also include reference to the district nurses’ visits and records and GP’s visits and any changes in treatment. Review staff working patterns and hours to allow for sufficient rest days between shifts and avoid allocating both night and day duties within the same working week. Ensure that staff are aware of their responsibilities and consistently follow safe working practices, for example, in relation to safe storage of hazardous substances and trip hazards, through regular monitoring and ‘spot checks’ of the environment. 2. OP27 3. OP38 St Anne`s Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Residential Home DS0000062413.V363181.R01.S.doc Version 5.2 Page 33 - 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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