Inspection on 23/05/05 for St Anthony`s

This inspection was carried out on 23rd May 2005.

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

The inspector 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 Anthony`s 09/05/07

St Anthony`s 09/01/07

St Anthony`s 11/05/06

St Anthony`s 07/02/06

St Anthony`s 02/11/04

St Anthony`s 10/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE St Anthonys 3 Mildred Avenue Watford Hertfordshire WD18 7DY Lead Inspector Julia Bradshaw Unannounced 23.05.05 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 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 Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Anthonys Address 3 Mildred Avenue Watfrod Herts WD18 7DY 01923 226174 0208 868 8375 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) RMD Enterprises Limited Mrs B Rellis Care Home 22 Category(ies) of OP OP Old Age 22 registration, with number of places St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2nd November 2004 Brief Description of the Service: St Anthony’s is a care home providing personal care and accommodation for 22 older people.It is owned by RMD Enterprises Limited, which is a private company. The home is situated in a popular residential area of Watford, within 15 minutes walking distance of the town centre, with easy access to local transport inks. The home was opened in 1985 and consists of a two-storey house that has been extended and improved over recent years. All the home’s bedrooms are single. None have en-suite facilities, but all have a washbasin. There is a passenger lift. The home has a beautiful and well-designed garden to the rear of the property, which is both safe and accessible to all the service users. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one day. The majority of time was spent talking to service users and staff. Some time was spent in the office looking at risk assessments; staff files and a tour of the environment. Discussions were held with the manager Mrs Bernie Rellis and several senior and care support staff. Service users were welcoming and an invitation was made to join them, at their lunchtime meal. Generally this was a positive inspection. Feedback received was excellent and the standard of most aspects observed are high. There were requirements made in relation to the environment and staff training. What the service does well: What has improved since the last inspection? There is little that the proprietor and staff at St Anthony’s needed to implement from the last inspection report as there was only one requirement made. However the manager has improved and developed the staff supervision programme, which now provides regular supervisions and staff meetings. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 Information available to prospective service users is comprehensive and informative enabling a decision to be made about admission. The atmosphere in the home is relaxed offering a welcoming environment to prospective service users. EVIDENCE: The home maintains adequate information within both the Statement of Purpose and the service user guide. These were both checked on the day of the inspection and cover all areas outlined within Schedule 1.This document should be updated annually or sooner if the service changes. Therefore this document should be updated before the next inspection takes place. The home has an adequate pre- admission assessment procedure so that all prospective new service users have an opportunity to visit the home. The proprietor and the manager carry out a needs assessment and have the final decision regarding admission. On the day of the inspection the home had five vacancies. One service user was in the hospital. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 9 An information file is available to potential service users and representatives, which includes the Service Users Guide, Statement of Terms and Conditions, information about fees, Complaints Procedure. The manager/proprietor must ensure that a copy of the service user contract is on each individual file stating the terms and conditions of their stay. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 10 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 standard(s) 7,8,9,10. Personal care and assistance offered to service users is of a very high standard, thus meeting the individual needs of the residents, whilst maintaining dignity and respect. Care staff are unobtrusive and sensitive in there approach. Care plans are detailed and are reviewed regularly ensuring changes to health and social care needs are recognised and met. EVIDENCE: Care plans were detailed and had been reviewed since the last inspection was carried out and the manager has a system of auditing these care plans on a monthly basis. Four service user spoken to regarding their care plan confirmed that they had been involved at varying levels with its compilation and implementation. Manual handling risk assessments were available on file and the manager has worked hard to implement individual risk assessments for service users living within the home. The manager stated the home has good working relationships with outside health professionals and support services. Individual care practice observed St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 11 was commendable. Service users requiring assistance with meals are seated in the smaller lounge/dining area where dignity was promoted and protected. The medication procedures within the home are robust and detailed and all medication was being administered appropriately through a dosette system of dispensing. The home uses a local pharmacy and there had been a recent visit (20/5/05) by the pharmacist to inform the manager of some recent changes to the ordering and dispensing of medication to the home. The home currently has no controlled medication although the manager is fully conversant with the current statutory requirements if this situation changes. All medication is being stored appropriately and the home maintains a variety of homely remedies, which have been individually written up by the G.P. The manager carries out a weekly audit on the medication system in order to identify any errors that may occur and to rectify these immediately. All staff receives a full induction before they are cleared to administer medication to the service users. The home also receives a positive and effective service from the local GP’S and health care professionals. Service users are able to maintain their own GP wherever possible. There are regular visits from other professionals, which include opticians, dentist and chiropodist. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 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 standard(s) 12,13,14,15. Where possible the home tries to accommodate everyone’s individual preferences and feedback and suggestions are sought in all aspects. This promotes autonomy and choice. Visitors are welcome and the home promotes integration with the local community in accordance with service users preferences. The home does not currently provide adequate opportunities for service user to take part in activities outside of the home. EVIDENCE: The home currently provides activities that are centred within the home which include quiz’s, bingo, sing-a-longs and “I spy sessions”. However there was a consensus of opinion form service users that they would like the home to offer some trips outside of the home to places of local interest and to have the opportunity to go out for lunch and visit the local garden centres. Some service users are able to visit the local shops independently and all carry identification if a situation occurs where they may need help or support to get home. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 13 The home has a hairdressing service that visits the home twice a week and this event appears to be popular and well attended. The home displayed a wealth of books within the entrance hall and a selection of board games is available. There is a television in the main lounge and a music centre. Also one service user stated how she had difficulty in reading due to her failing eyesight and therefore the home had endeavoured to ask the family to provide her with a selection of “talking books”. The current menus provide are both well balanced and varied, with the meal provided on this unannounced inspection as outstanding quality and enjoyed by all service users. The cook is both knowledgeable and experienced in the provision of wholesome and creative meals. There is fresh fruit made available on a daily basis and several service users spoken to during lunch could not fault the food and were highly complimentary about the standard of meals within the home. The cook has recently updated her food hygiene training. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 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 standard(s) 16,18 The home has a robust complaints procedure of which all service users spoken to were fully aware ensuring that all issues can be dealt with effectively. The manager and proprietor have a presence within the home thus safeguarding service users. EVIDENCE: A copy of the complaints procedure is available to prospective and current service users. Reference is made to the Commission for Social Care Inspection. Those spoken to said that they have never had to make a complaint and felt that they would be able to speak to a member of staff or the manager if they had any concerns. One service user said ‘I cannot find any reason to have to make a complaint’. No complaints had been received since the last inspection. Staff confirmed they had received training on adult abuse and there is a copy of the Hertfordshire Adult protection procedure kept within the home. The manager stated that staff have received training on POVA. (Last training was in October 2004) Staff were aware of the homes Whistle Blowing procedure as a copy of this had been attached in the main office of the home. This appeared to be an effective way to remind staff of its presence. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 15 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 standard(s) 19,20,25,26 Several areas of the home are in need of decorating and improvement The home is clean and bedrooms are personalised offering a homely, lived in feel. Service users health and safety is currently compromised due to some area of the home being in a poor state of repair. EVIDENCE: There are several areas of the home that require attention due to either general wear and tear or due to poor maintenance. The main areas of concern are the corridor flooring outside room 14,15 and 18 which is uneven and the carpet is badly worn. Also there has been a leak outside room 18 where the ceiling has been damaged and part of the ceiling has fallen down. Several rooms require new bedroom carpets and the communal areas of the home all require re-decoration. The corridor carpet on the first floor needs replacing as in some areas it is badly worn and sticking tape has been used to hold it together. There is a crack in the wall, near the light switch in room 10 that requires repairing. The bath panel in one of the bathroom upstairs needs St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 16 replacing. Also both bathrooms require re-decorating as they appear quite sparse and were described as being “tatty”. The dining room flooring needs replacing as it is badly worn and uneven. The other main area of concern is that the current and only hoist, does not fit into every bedroom. This requires replacing immediately in order to ensure that the standard of health and safety is maintained within the home. The kitchen on the day of the inspection was far too hot and requires additional ventilation to improve the circulation of cool air, especially when the warmer months arrive. The cook was finding the working conditions almost unbearable when preparing the mid-day meal. The manager and staff have worked hard to ensure that all the service users bedrooms are personalised and comfortable and this is an area that the home does exceptionally well and should be congratulated. The standard of cleanliness within the home is excellent and all areas of the home were odour free on the day of the inspection, with the exception of one bedroom where the manager is considering replacing the current carpet with a more suitable impervious covering to manage a problem of incontinence. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The The The The staff team are enthusiastic and appear to take great pride in the service. skills and experience of the staff is varied. manager follows a robust recruitment procedure. manager is providing adequate training with the exception of fire training. EVIDENCE: The manager stated that the home was fully staffed and that the staffing levels are adequate to meet the required needs of the current service user group. These ratios provide a minimum of four/five staff on both the morning and evening shifts and three-night car per night. The manager has worked hard to improve and develop the supervision programme for all staff and this includes annual appraisals, which are carried out by the proprietor. Service users were complimentary about the staff and management of the home. Stating ‘ the carers are good, they look after us and are very kind’. Staff spoken to confirmed that they are receiving a variety of training, which includes, manual handling, food hygiene, dementia and elder abuse (October 2004). One member of staff currently has NVQ level 2 and one member of staff has NVQ level 3. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 18 There was inadequate evidence to confirm that all staff have received appropriate fire training and therefore this presents a current risk to both service users and staff. There was a lengthy discussion with the manager regarding the current arrangements for fire drills and evacuation procedures. The manager has never carried out a full fire evacuation procedure since managing the home for the past 22 years. This is not a requirement by the fire brigade of the Commission but consider it good practice to carry out this procedure with the staff team at least once. The manager agreed to contact the local Fire prevention officer for further advice regarding this issue. All recruitment procedures are being carried out effectively in order to ensure the protection of service users. However the two staff files that were checked did not provide the names of the referees on the reference request form i.e. When the referee replied to the request from the home for a reference there was no evidence on the form of who had written the reference and the name of the Company. The manager agreed to raise this issue with the proprietor and amend the form in order to give the full details of each referee. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38 The home is well managed and offers a high standard of care to service users. Health and safety procedures need to be improved. Service users financial interests are safeguarded by robust accounting procedures. Staff are appropriately supervised. EVIDENCE: The manager communicates a clear sense of leadership within the home, and promotes a sense of belong to it’s service users. Pride and dedication is taken in every aspect. Service users commented on how efficiently the manager has dealt with their requests. Staff meetings are held regularly and minutes are kept and signed. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 20 Service users or their relatives handle their own money wherever possible however the home has a pocket money holding system. This is where service users choose to keep small amounts of money in the safe which pays for hairdressing, newspapers etc. Residents are offered a key to their room upon arrival. All care staff within the home are adequately and suitably trained in order to meet the changing needs of the service users, with the exception of fire training which must be implemented immediately. All records checked on the day of the inspection were being adequately maintained; this includes health and safety documentation, the Adult protection policy, COSHH. Service user files were adequate and contained all the necessary information and the manager conducts a detailed and comprehensive medication system within the home. The area of concern regarding health and safety is focused on the environment where the proprietor must address all the issues identified on the day of the inspection and in this report. The manager is endeavouring to implement a formal quality Assurance system into the home in order to have a “tool” to review and improve the areas of development that can be identified. The manager currently carries out this process in an “informal” way but has recognised this should be developed more formally. The manager has daily contact with all the service users living at the home and is therefore able to address any concerns or issues that may occur regarding the current service provided. The manager must ensure that all areas of induction are formally recorded with a particular focus on fire procedures and fire prevention. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 4 COMPLAINTS AND PROTECTION 2 3 3 1 x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 x 2 St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2.1 Regulation 5 (1) (c) Requirement The proprietor must ensure a copy of the current contract that has been signed by the service user or their representative is maintained within the home at all times. The proprietor and manager must endeavour to respond to requests from the service users regarding the opportunity to enjoy activities outside of the home ,especially during the Summer months. The proprietor must ensure that there is adequate ventilation within the kitchn area. The proprietor must replace all bedroom carpets that are badly worn. The proprietor must repair the ceiling outside room 18. The proprietor must repair and level out the flooring outside rooms 13,14,18 and replace the corridoor carpet. The propreitor must replace the corridoor carpet on the first floor. The proprietor must replace the current hoist with one that can be accessed by ALL service users Timescale for action 30/6/05 2. 12.2 12 (3) 30/6/05 3. 4. 5. 6. 38.1 24.2 19.1 19.1 23 (2) (p) 16 (2) (c) 23 (2) (a) 23 (2) (b) 30/6/05 31/7/05 5/6/05 5/6/05 7. 8. 19.1 22.1 16 (2) (c) 23 (2) (n) 31/7/05 1/6/05 St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 23 9. 10. 11. 19.1 19.1 30.1 16 (2) (c) 23 (2) (d) 18 (1) (c) (i)and 23 (4) (d) The diningroom flooring needs replacing Both bathrooms need redecorating Fire training must be provided and all madatory training kept up to date.The fire training is an oustanding requirement from the previous inspection. 31/7/05 31/8/05 1/6/05 12. 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 30.2 Good Practice Recommendations All fire induction procedures must be recorded and should be signed by both parties. St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Anthonys I52 s19534 St Anthonys v229952 230505 stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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