CARE HOMES FOR OLDER PEOPLE
St Annes 30 Lansdowne Road Luton LU3 1EE Lead Inspector
Leonorah Milton Unannounced Inspection 16th February 2006 14.00 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 Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Annes Address 30 Lansdowne Road Luton LU3 1EE 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) 01582 726265 01582 726265 Mr Cornelius Crowley Mrs Kathleen Bernadette Lysaght Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20), of places Physical disability over 65 years of age (20) St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd July 2005 Brief Description of the Service: St Annes is registered to provide residential care services for 20 older people who may also have dementia and limited physical disabilities. The property, close to Luton town centre, is well maintained and comfortably furnished. Private accommodation is distributed on all of the homes three floors and consists of 18 single bedrooms and one double bedroom. All of the bedrooms are fitted with washbasin facilities, nine have en-suite toilets and all had an emergency call bell. The rooms on the upper floors can be accessed by a passenger lift. Toilet and bathing facilities are located on each floor. There is a large combined lounge/diner that incorporates a smaller lounge area on the ground floor. There is also a quiet lounge on the first floor. Hard standing to the front of the home provides limited car parking. Time limited road parking is available in the area. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focussed the core standards not assessed at the first visit and reviewed the progress on requirements from that inspection. During this inspection the arrangements for the care of two service users were assessed. Their case files were reviewed, as were their private bedrooms. Conversations took place with one of these service users, two other service users and their visitors. Discussions also took place with two members of staff who were in charge during the manager’s absence. A partial tour of the building took place and sundry other records were assessed. The majority of the inspection took place with the service users in the rear lounge/diner, where the arrangements for recreation and relaxation were also assessed. It is recommended that this report be read in conjunction with the report of the inspection carried out in July 2005 for a complete overview of the standard of the operation between these dates. What the service does well:
The home had been managed and organised to a good standard. Records seen at this inspection had been well maintained. Procedural guidance was available to staff. They were observed to go about their business during the absence of the manager in a confident manner. Personnel reported good working relationships with the manager and stated they were satisfied with the support they received to carry out their roles. The home had a relaxed and friendly atmosphere. A good deal of informal banter was observed between service users and members of staff. This was evidently enjoyed by service users who smiled and responded well to this repartee. One stated that, “ we have a laugh” and said that she enjoyed the fun. It was evident that service users had confidence in the home’s ability to care for them. The conduct of the team had influenced this opinion; Service users and their visitors passed many compliments about the standard of care. One said, “You couldn’t find a better place”. The team as a whole were described as kind, nice and helpful. A visitor commented that the home had a local
St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 6 reputation for providing a good standard of care. She said that she visited frequently and had always been made welcome. She had noted that service users were always treated with kindness and respect and that their requests for assistance were responded to promptly. In similar vein service users passed positive comments about the quality and quality of the food and said that there were offered alternatives to the main menu if it was not to their taste. They expressed satisfaction with the laundry service. It was noted that service users were smartly dressed and looked well groomed. Whilst two service users were not aware that the home had a complaints procedure, they both confirmed that they felt able to raise concerns with the staff if need be, but had not had any occasion to do so. There was evidence that service users had been provided with opportunities to join in recreational activities and religious services. There was also evidence to show that service users, visitors, and other professionals had been invited to comment on the quality of the service. A copy of this survey was available in the entrance foyer to the home, as was its written guide to the service provided at St Annes. What has improved since the last inspection? What they could do better:
The person in charge explained that the manager spends three days at the home each week. At this inspection, the person in charge during her absence were not fully aware of steps that would need to be taken if an allegation of a serious abuse of a service user was made. Persons left in charge must be fully briefed about actions to take in any emergency situation. There must also be a review of actions in the event of a fire at night. The home currently has one waking member of staff during the night and another sleeping in on the third floor. It was explained that if an alarm were activated, the waking member of staff would wake up/summon the sleeping in member of staff via a walkie/talkie device and then call the fire brigade. This could result in an unnecessary delay to call the emergency services. The manager must supply the CSCI with an evaluation of the night staffing arrangements, which takes account of the needs of individual service users, the layout of the building, the risks of lone staff working, fire safety and staffing competencies.
St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 7 The home has a central heating systems to provide heating throughout the home. However some service users have requested additional heating in their rooms as they wish the level of heating to be higher than that provided via the main system. Freestanding heaters are currently used to meet the individual needs but these must be evaluated to ensure that they pose no risk of accidental burn or trip hazard to service users. In addition an unprotected radiator must be covered. Bleach and any other substances that might be harmful to service users must be stored securely. Waste bins in bathrooms and toilets must have lids. Used continence materials must be double wrapped to prevent any contamination during disposal. Documents such as district nursing notes must not be stored in the laundry to ensure there is no risk of cross-contamination. Medications for storage under refrigerated conditions must also be stored securely. It is suggested that a purpose fridge is obtained. Service users should be given the opportunity to visit the home before admission so that they are able to make an informed decision to move into the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 The written guidance to the service was of a good standard to assist service users to make an informed choice about moving into the home. However, not every service user had been able to make such a decision about moving into the home. EVIDENCE: The home’s statement of purpose and service user guide was available to service users and their representatives on entry to the building. The documents provided a detailed and clear guide to the service provision. The documents provided examples of service users’ feedback on the quality of the service but no copy of the report on the most recent inspection of the home by the CSCI or a standard contract. The manager subsequently informed the inspector that the guide made reference to a copy of the most recent inspection report being available in the office. The case files assessed at this inspection showed that detailed information had been supplied by placing authorities in addition to the home’s assessment to
St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 10 ensure that the home was able to judge that it had the ability to meet service users’ needs. A service user stated that she had been living in another care home for a temporary period of rehabilitation before her transfer to St Annes. The Local Authority who was funding her placement had arranged the tranfer. She stated that she had not known until the morning of the transfer that she was moving and that she had been upset not to have had the opportunity to visit St Annes before moving in and had been worried about the unknown. She also stated however, that since transfer she had no reason to regret the move and she was satisfied with her care. Her visitor, who was her next of kin, stated that had been a delay to inform her about the service user’s transfer and she had been told two days after the event by the Local Authority. Whilst it may be that the Local Authority was mainly responsible for this situation, the home needs to make sure that those who are capable of visiting the home prior to admission, are invited by the home to do so and that the Local Authority is informed about the home’s philosophy on this. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, 10 Service users’ rights privacy and to be treated with respect and courtesy had been maintained. EVIDENCE: Service users and their visitors confirmed that that they had been treated with courtesy at all times. Members of staff were observed to be respectful in their dialogue with service users and to knock on bedroom doors before entering. Whilst procedures for the administration and storage of medicines were not assessed in full it was noted that an antibiotic suspension and eye drops were stored in the unsecured refrigerator in the home’s kitchen. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Service users had been supported to make choices and control aspects of their lifestyle where it was safe and practical to their wellbeing to do so. However it was clear that at least one person was not aware about her right to see her records. EVIDENCE: The majority of service users had some form of memory loss and relied on staff to make decisions about their daily routines/lifestyle. However it was evident that where possible these service users had been supported to make some choices such as times for bed and getting up, food preferences and bathing routines: Service users stated that there were no “rules” about the above and they could make these choices. Case files contained records of service users’ preferences about these issues. The central record of bathing routines indicated that these were organised around service users’ choice rather than imposed routines. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 13 One service user stated that she was aware that daily notes were kept about her but she was not aware that there was a plan of care for her individual needs. She stated that she did not know she had the right to see records about her care. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Whilst the home had robust protection procedures, those in charge were not sufficiently versed in them or confident about actions they must take as the lead person on shift if an allegation were to be made to ensure the protection of other service users. EVIDENCE: The home had a satisfactory complaints procedure and had other less formal systems to enable service users to voice their opinions. Service users stated that they felt able to raise concerns. One said that a recent complaint in relation to being disturbed in the evening by loud music from a nearby bedroom had been dealt with. The home’s procedures in relation to the prevention from abuse were robust and accessible to staff. Two persons with key holder responsibilities were spoken to at this inspection. Whilst they had many years experience at the home and had undertaken training in relation to their roles neither person had undertaken formal training in the procedures that must be in place to ensure that service users are protected from abuse. Both members of staff however did show an awareness of what constitutes abuse but did not know that allegations of a serious nature must be reported to the Local Authority. Both stated that in the event of an allegation that would contact their line manager.
St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 15 One also stated that although she would wish to send any member of staff home if allegations were made about them, she doubted if members of staff would take such an instruction from her, as she did not hold that authority. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26 The building was mostly suitable for the needs of service users but breaches to safety were noted that could result in serious consequences to the wellbeing of service users. EVIDENCE: Five users’ bedrooms were assessed. Each was clean and orderly. Most were well decorated. The lower sections of the walls of one bedroom were marked and needed repainting. Four of the rooms contained many items of a personal nature and mementoes of past lives. The fifth was mostly devoid of personal possessions. One bedroom contained a radiator that was not covered to prevent the risk of accidental burn. The service user who occupied this room was in hospital but there was still a risk to other service users of accidental burn because the room was unlocked and was therefore accessible to those who might wander. The staffing arrangements at night raised the risk element of this situation.
St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 17 One bedroom contained a free standing heater and also a fan heater. It was reported that the surfaces of the freestanding heater became very hot when switched on. Both heaters presented trip hazards to the occupant of the room who was described as mobile. It was reported that another room required backup heating from a freestanding heater. It was noted that not all bedrooms contained lockable facilities or locks to bedrooms doors that could be used with a key. However, a service user who managed her own monies stated that she had a lockable facility in her room. Case files should contain risk assessments to show why service users are not able to manage keys to their rooms or lockable facilities. These were not seen on the case files assessed at this inspection and which were applicable to the service users’ abilities. One toilet and one bathing facility that also contained a toilet were assessed. The waste bins in each room were without lids. Both bins contained unwrapped soiled continence materials. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 The members of staff on duty were sufficiently experienced and skilled to meet service users’ every day needs. However, there was a risk that there would be delay to meet service users’ needs and safety at night because of inadequate staffing arrangements EVIDENCE: The majority of the staff had worked in the home for several years and were well acquainted with service users’ needs and the routines of the home. The staff on duty presented as a cohesive team and worked well together. The members of staff spoken to expressed satisfaction with their employment, the support they received from the manager and stated that they enjoyed caring for the service users. Observation of practiced and the testimonies of service users and their visitors identified that the care staff were providing sufficient care for service users throughout the day. The rota indicated that four members of care staff were rostered throughout the day and evening on each of the seven-day working week to meet minimum staffing requirements. There were no additional management hours allocated to shift leaders during the manager’s absence. A cook was rostered to prepare breakfast and the mid day meal. A domestic assistant was employed seven mornings each week. Members of the care staff carried out laundry duties. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 19 Rotas also indicated that one waking and one sleeping in member of the care staff team staff were rostered each night. It was explained that night staff also had delegated cleaning duties and would also complete any outstanding laundry. The manager subsequently explained that there a risk assessment was in place to qualify the night staffing arrangements and agreed to forward a copy to the CSCI. However given the numbers of service users, the layout of the building over three floors and the additional duties other than the care of service users, the night staffing arrangements were inadequate. The manager also explained that the staffing qualifications indicated in the service user guide required updating and that the actual achievement of the care team of fourteen and her were as follows: Nine held a National Vocation Award in Care (NVQ) at level 2. Four were working on the last module to complete the award at level 2. Two were working towards NVQ at level 2. The manager had achieved the Registered Manager’s Award, equivalent to NVQ level 4 in management. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,38 There were strategies in place to enable service users and other stakeholders to comment on the service. Although the home had risk management strategies in place the inspection showed that there were still risks that required urgent action to ensure the safety of service users and also staff in the building at night. EVIDENCE: (Please note that it was not possible to assess standard 35 at this inspection. The arrangements to meet this standard will be reviewed at the next inspection.) As noted in the summary to this report the service user guide available on entry to the home contained the results of quality audit processes. One was a document dated January 2006 that reported on a survey that had canvassed the opinions of other professionals and which showed an overall positive view
St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 21 of the service. Other documents referred to a similar process with service users held in November 2004. The inspector was not sure whether this particular exercise had been repeated, as is required on an annual basis. If so the service user guide will need to be updated. Breaches to safety have already been noted on this report with regard to fire evacuation, risks of accidental burn or trip and from contamination. It was also noted at this inspection that that several bottles of bleach were accessible in the unlocked room used by staff for sleeping-in. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 22 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 2 x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x 1 2 1 STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x x x 1 St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 5 (1)(c)(d) 12(2)(3)4 (1)(c)(d) 3 OP9 13(2) Requirement A copy of the last inspection report and a standard contract must be included in the service user guide. Service users must be given the opportunity to visit the home prior to admission in order to make an informed choice about moving into the home. Medicines must be stored securely. This must include those for storage under refrigerated conditions. Personnel left in charge must be made aware of the sequence for reporting allegations of abuse to statutory authorities. They must be given sufficient authority to take any other necessary steps to protect service users to include exclusion from the building of any person accused of abuse. Staff must be provided with training in procedures for the protection of service users from abuse. The integral heating systems throughout the home must be
DS0000014958.V282891.R02.S.doc Timescale for action 31/03/06 2 OP5 28/02/06 31/03/06 4 OP18 13(6) 28/02/06 5 OP18 23(2)(p) 31/08/06 6 OP25 13(4)(c) 30/06/06 St Annes Version 5.1 Page 24 7 8 OP25 OP26 13(4)(c) 13(3) 9 OP26 13(3) 16(1)(k) 10 OP27 13(4)(c)1 8(1)(a) 11 OP38 23(d)(e) 12 OP38 13(4)(c) sufficient to provide comfortable ambient room temperature that do not rely on secondary heating methods. The risks of accidental burn and trip from the use of freestanding heaters must be assessed. Documents, such as district nursing notes and similar in relation to the care of individual service users, must not be stored in the laundry to minimise the risk of cross contamination. Used continence materials must be disposed of safely to prevent the spread of infection: waste bins must be provided with lids. Soiled continence materials must be double wrapped for disposal. Sufficient staff must be rostered throughout the night to meet service users’ needs, safety requirements and their additional delegated tasks. This must be a minimum of two waking night staff, unless a risk assessment can show why this staffing arrangement is not necessary. In which case a copy of this assessment must be forwarded to the CSCI. Night staff must be briefed about the priority of contacting the fire and rescue services without delay. Service users must not have access to bleach and other harmful products. 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 25 No. 1 2 Refer to Standard OP14 OP24 Good Practice Recommendations Service users should be informed that they have the right to see records made about them unless their assessed levels of ability precludes this. Case files should contain risk assessments to show why service users are not able to manage keys to their rooms or lockable facilities. St Annes DS0000014958.V282891.R02.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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