Inspection on 09/05/07 for St Anthony`s

This inspection was carried out on 9th May 2007.

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 09/01/07

St Anthony`s 11/05/06

St Anthony`s 07/02/06

St Anthony`s 23/05/05

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 Anthony`s 3 Mildred Avenue Watford Hertfordshire WD18 7DY Lead Inspector Mrs Sheila Knopp Unannounced Inspection 9th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Anthony`s DS0000019534.V336001.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 Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Anthony`s Address 3 Mildred Avenue Watford Hertfordshire WD18 7DY 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) 01923 226 174 0208 8688375 rmd@ukgateway.net RMD Enterprises Limited Mrs Devereux Lisa Souter Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: St Anthonys 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 links. The home was opened in 1985 and consists of a two-storey house that has been extended and improved over recent years. There are 20 single rooms and 1 double room. None have en-suite facilities, but all have a washbasin. Six of the bedrooms are smaller than the 10 square metres required of newly registered services since 2002. 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. The current fees for accommodation and personal care range from £435.00 - £475.00 based on room sizes (correct on 9/5/07). Additional charges are made for items such as newspapers, chiropody and hairdressing where required. Information about the service can be obtained from the Statement of Purpose, the Service User Guide and the last CSCI inspection report, which can be obtained from the manager. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information in this report is based on an unannounced visit to the home where the inspector met 6 residents 3 visitors 4 staff. Information received by the Commission since the last inspection on 9/1/07 has been reviewed. No concerns have been reported regarding the quality of service provided to the people who live at St Anthony’s. What the service does well: Residents and visitors describe St Anthony’s as being a friendly home. A relative of a resident who had just moved to St Anthony’s said they knew it was the right place as it was ‘small, friendly and felt like home’. Another resident said the staff were ‘all very helpful and kind’. One person said they came to St Anthony’s for a short break and liked it so much they stayed. Residents and their visitors confirm staff keep them well informed about any changes and that they find this reassuring. The residents enjoy their meals and have daily contact with the cook who discusses the meals planned for the day and asks them what they would like. Prior to the inspection in January 2007 relatives and health & social care professionals were asked for their views. The surveys that were returned expressed a high level of satisfaction. Residents continue to have their health needs very well supported and the findings of this inspection confirm that these views are still valid. One GP said St Anthony’s was ‘the best home in Watford. Two others described it as ‘one of the better homes in the area’. Other GPs described St Anthony’s as providing a ‘satisfactory level of care’, ‘excellent care’ and as ‘sensible, kind, efficient and safe’. A social worker said ‘This home has warm friendly caring staff and a lovely happy environment’. St Anthony’s has a private garden, which residents can sit and walk in. It provides a tranquil area for residents to view the wild life and colourful scented flowers and shrubs. The home is well managed by the registered manager who keeps herself up to date with current research and practice in elderly care to promote the interests and well being of the people who live at St Anthony’s. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 (standard 6 does not apply to this service). People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager visits people considering moving to St Anthony’s in their own home or hospital to assess them and ensure staff can meet their needs. Information from hospitals, doctors and social workers is also reviewed to make sure up to date information is available to staff. Individuals and their relatives are encouraged to visit before making their choice. EVIDENCE: A new resident and their relative confirmed that the staff at St Anthony’s were meeting their needs and that they were happy here. They had chosen the home for it’s location and liked its small size. Information was available about the assessment process the manager had carried out before the individual was admitted and the plan of care put in place detailing their care needs. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care, which sets out their needs and how they wish to be supported. This information is regularly reviewed and updated with the involvement of the resident and their relatives. Residents have good access to local GPs and the services of dentists, opticians, chiropodists and Community Nurses. There are good systems in place to ensure residents receive the medicines they require. Residents feel they are treated with respect and their privacy is maintained. EVIDENCE: The care plans of four people who had discussions with the inspector were reviewed. These records were found to be informative and up to date. The residents are involved in developing their plan of care and the manager has introduced regular 6 month reviews for all residents in addition to the annual reviews carried out by social services on the residents it funds. The reviews may take place over a number of sessions to enable the individual to take it in St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 10 and consider the information. One person said they recently reviewed their care plan with the manager. There is good information available regarding health care matters that demonstrate the manager is proactive in reviewing changing needs and making referrals to outside agencies who can provide the necessary support, guidance, equipment and treatment. A resident said staff were sensitive to their changing needs and where available to provide support when needed. The previous inspection report confirmed a high level of satisfaction from GP’s who have contact with residents at St Anthony’s. No residents were reported to have pressure sores. The manager regularly reviews the competency of staff to administer medication and there are good auditing systems in place to check procedures are being followed and residents receive the medication they are prescribed. Advice from the Commissions regional pharmacist, to get residents to sign their consent to staff administering medication, was passed on to the manager for consideration A medicines refrigerator is not available so medication would not be kept securely and away from food products should this be required. However, no items required cool storage at the time of this inspection. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 11 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 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall the residents were satisfied with the approach taken to providing recreational activities within the home. Visitors are welcome in the home, which enables residents to maintain positive contact with family members and friends. Service users are provided with a varied seasonal menu and enjoy their meals. They have daily contact with cook to discuss their preferences. EVIDENCE: Residents are provided with a variety of things to do and records of the recreational activities and events residents have taken part in are kept. The garden is a relaxing haven of flowers and wildlife. Bird tables on the patio provide a focus during the winter. The library books are replaced every two months by the library service and several residents were making use of the books. The spiritual needs of residents are supported and as well as visiting church representatives residents are supported to go out to church. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 12 Staff spend time with residents encouraging one to one activities such as board games, puzzles, quizzes, knitting and artwork. Residents are able to have a daily newspaper. The residents confirmed they were pleased with the standard of meals. The cook meets with residents each day and is able to respond to changes. The menu based on home cooking the residents would be familiar with, looked varied and included fresh seasonal vegetables. Fruit and snacks are available. Residents had access to drinks throughout the day and visitors confirmed they were also offered tea, coffee and biscuits when they visited. The last inspection reported that residents were involved in revising the menu and tasting various brands of bread before choosing the one to be ordered. The last inspection recommended the purchase of matching crockery to improve the quality of the service provided to residents as the items were of matching colour but varying styles. It was reported that this has not yet been ordered. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 13 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): Standards 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users and their relatives can be confident from the approach of staff and the procedures in place that their concerns will be listened to and followed up. There is an open and supportive culture within the home, which does not raise anxieties for residents or their relatives. Staff receive training in protecting service users so they are aware of their responsibilities and there are procedures in place detailing the action to take if concerns are identified. EVIDENCE: The inspector was shown letters and cards thanking the staff for their support. The manager has received no complaints since the last inspection. The manager has day-to-day contact with residents and their relatives, which enables issues to be identified at an early stage and dealt with. The complaints procedure in place details how to make a complaint and what to do if the person making the complaint is not satisfied. Timescales for expected responses are included. The staff interviewed are aware of their responsibilities to report any concerns to the manager. The manager is aware of her role under the Hertfordshire St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 14 Safe Guarding Adult procedure and a copy of the procedure is available in the home. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. St Anthony’s provides residents with fresh clean accommodation that has a homely domestic feel to it. There is a well-tended private garden to walk and sit in during the summer. With the dependency of residents increasing there is a need to review the assisted bathing and toilet facilities available to provide residents with better access as residents reported that they sometimes have to wait for these facilities. Residents are not adequately protected from accidental scalding from hot radiator surfaces Residents are provided with smartly laundered clothing and bed linen. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 16 EVIDENCE: Residents are encouraged to add personal possessions to their rooms. Following the last inspection the owner provided timescales for redecoration and replacement of flooring and furniture to improve the quality of the environment. The manager has since confirmed that work has started on the decoration of the entrance hall and reception area and will them move to the dining area and lounges. When purchasing new furniture lockable drawers should be provided for bedrooms and lounge chairs provided to suit people of varying heights. There is only one toilet on the ground floor that is big enough for staff to assist someone in a wheelchair. A resident said this meant at times they had to wait until it was available. Similarly the bathrooms do not enable staff to work from both sides of the bath when helping residents who use the bath hoist. Window restrictors are provided on the windows above ground level to prevent accidental falls. Following the last inspection a radiator cover was fitted to a radiator, which was close to a bed to prevent accidental scalding if some one should fall against it. Further issues related to hot radiator surfaces where identified at this inspection and are referred to under Standard 38 of this report. The manager has been asked to contact the local fire safety service to check whether hazard signs and a lock are required on the first floor boiler room door. Following the inspection the manager confirmed an official oxygen sign to alert the emergency services to the use of oxygen in a specific room, has been provided. Residents were wearing smartly laundered clothing. The laundry systems support good infection control practices and have benefited from extensive upgrading in recent years. Liquid soap and disposable hand towels are available in key areas to support good hand hygiene practices. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 18, 19 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents report that they have good relationships with the staff who look after them. The manager is monitoring the allocation of staff during the day and with the support of the owner has achieved additional time for staff to spend with residents by employing new staff to manage laundry and housekeeping duties. The manager ensures that the recruitment procedures are followed and suitable people are employed to work with vulnerable people. There is an induction programme in place to ensure staff are introduced to the principles of caring for older people but limited access to some courses means staff have to wait along time to receive their statutory training. EVIDENCE: The staff rota indicates 5 staff plus the manager work in the morning and three staff in the afternoon. The manager reported further adjustments to the rota had been agreed, which would enable the chef rather than care staff to prepare the evening meal and a weekend chef to be employed. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 18 The manager reported a number of staff have dropped out of their NVQ training which is affecting the percentage of the staff team who have achieved this qualification. A number of staff however have overseas nursing qualifications. Information regarding the statutory training required by staff is detailed under Standard 38 of this report. The records of a new member of staff employed since the last inspection were reviewed and confirmed that the required checks including two references and a criminal records bureau check are obtained. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current manager of the home is up to date with current practice, in relation to supporting older people and has the management skills and experience to run a care home. There is not a professionally recognised quality assurance system in place, which would enable a more systematic review of the service provided to residents. Residents are able to deposit small amounts of money for safekeeping. Records were not available to demonstrate all staff had received the statutory training they require to implement safe working practices. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager has the required experience, qualifications and skills to carry out her role. The systems she has introduced since taking up her post have moved the home forward in terms of implementing current practice and demonstrate a commitment to providing a good quality service for the people who live at St Anthony’s. There is no system for systematically reviewing all areas of the service provided and the provider did not respond to the requirement made by the Commission that a monthly report on the outcome of visits to the home should be made available to the manager. Residents and their relatives are asked for their views on the service provided. The provider has relied on risk assessments and thermostats on radiators to protect residents from raised surface temperatures, which may scald them. The inspector has identified problems with this approach, which relies on the vigilance of staff. The surface temperature of a radiator behind a bedroom door was recorded at 52.70C. Health & safety guidance states that radiator surfaces should not exceed 430C when operating at maximum output. The manager has since confirmed that the broken thermostat has been replaced. Following the last inspection risk assessments for the safe use of equipment, such as recliner chairs brought in by residents, have been introduced. There are systems in place to enable residents to deposit small amounts of money. Records are maintained of deposits and withdrawals to demonstrate that money is kept securely and used appropriately. The manager was advised to take advice from the local fire safety officer regarding whether appropriate signs and locks were required on the first floor boiler room door to ensure the systems in place meet current fire safety legislation. The manager did not have records to demonstrate all staff had received their statutory health & safety, food hygiene, moving and handling and first aid training or that it was made available at the time new staff were being inducted. A previous inspection recommended that a training matrix be put in place to identify gaps. Not all night staff have received first aid training, which means there are gaps in cover. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 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 3 x 2 x 3 x x 2 St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement Timescale for action 31/07/07 2 OP33 26 Medicines, which need to be stored in a refrigerator, must be kept locked to protect residents. The provision of a drug refrigerator would also separate it from food items. To demonstrate full compliance 30/06/07 with Regulation 26 a copy of the reports for February & March 2007 must be provided. Requirement brought forward from report dated 09/01/07 as timescales for compliance not met (06/04/07) 09/05/07 - Forward copies of the monthly report to the Commission as they become available at the end each month. To protect residents and staff you must ensure: 1. New staff receive the required statutory training in first aid, moving and handling, food hygiene and health & safety within 12 weeks of employment. CSCI/Skills for Care: Guidance on Common Induction standards 04/07. DS0000019534.V336001.R01.S.doc 3 OP30 OP38 18 30/09/07 St Anthony`s Version 5.2 Page 23 4 OP38 13(4) 2. Ensure records are kept to demonstrate existing staff have had the required statutory training and updates. 3. A first aider needs to be available on each shift including the night shift To protect residents you must ensure the surface temperature of radiators does not exceed 430C. Consideration should be given to providing protective covers or low surface temperature radiators as the current control systems have proved to be flawed. 09/05/07 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 2 Refer to Standard OP9 OP38 Good Practice Recommendations Consider obtaining consent from residents who need staff to administer their medication. Take advice from the fire safety service regarding the provision of a lock and appropriate sign for the first floor boiler room door to ensure it meets current fire safety legislation. St Anthony`s DS0000019534.V336001.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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