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Inspection on 14/04/05 for St Anthonys Care Home

Also see our care home review for St Anthonys Care Home for more information

This inspection was carried out on 14th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The majority of service users expressed satisfaction with care staff and the staff were observed to present good skills and attitudes in their interactions with service users. There is a stable staff team that are undertaking appropriate training opportunities. The home provides single room accommodation that is comfortable and homely. The staff are ensuring that service users are accessing a range of health care services as required. Service users expressed approval of the catering arrangements, preferences and special diets are provided.

What has improved since the last inspection?

Mr and Mrs Lingham have provided service users with guides to the home detailing services, facilities available and the complaints process. Mrs Lingham is the registered manager and the rota now provides a clear record to show she is at the home and in day-to-day control. Service users stated their approval of the replacement stair lift and how they could move in safety between floor levels. The home is gradually providing radiator covers and regulators to control the temperature of hot water in all outlets to protect service users. The bathroom on the first floor was still not available to service users, although Mr Lingham explained that this area had been refurbished and a hoist would be fitted soon to complete this work.

What the care home could do better:

Mrs Lingham has agreed to provide detailed care plans for each service user so that care staff understand how personal, health and social care needs are to be met. This is the second inspection where Mr and Mrs Lingham have been required to ensure that appropriate heating is supplied for service users. Mr and Mrs Lingham have been asked to review the quality of care at the home and maintain communication with this Commission regarding developments and progress at the home.

CARE HOMES FOR OLDER PEOPLE St Anthonys Station Road Liskeard Cornwall PL14 4BY Lead Inspector Mike Stokes Unannounced 14 April 2005 10:15 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 D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Anthonys Address Station Road, Liskeard, Cornwall. PL14 4BY 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) 01579 342308 01579 342308 St Anthonys Limited, 6 Raleigh Walk, Waterfront 2000, Brigantine Place, Atlantic Wharf, Cardiff, Wales. CF10 4LN Mrs Judith Helen Lingham CRH 13 Category(ies) of 13 OP, 5 DE(E) registration, with number of places St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Serivce users to include 13 adults of old age (OP) 2. Service users to include up to 5 adults over 65 years of age with Dementia (DE(E)) 3. Total number of service users not to exceed a maximum of 13. Date of last inspection 01/11/04 Brief Description of the Service: St.Anthonys is a care home providing accommodation and personal care for up to 13 older persons. It is situated near the centre of Liskeard and the local amenities that include shops, health centres and railway station. Bedrooms are provided on both the ground and first floors, with a recently installed stair lift to assist service users. Communal areas are provided for service users on the ground floor and include a lounge and dininng room. There is a large private garden at the rear and car parking at the front of the home. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 14th April 2005 starting at 10:15 a.m. and lasted approximately 6 hours. During the inspection the majority of service users were spoken to and a tour of the premises took place. Mr and Mrs Lingham were present, various records, policies and procedures were inspected and staff members on duty also assisted in providing information about how the home is caring for people living there. What the service does well: What has improved since the last inspection? What they could do better: Mrs Lingham has agreed to provide detailed care plans for each service user so that care staff understand how personal, health and social care needs are to be met. This is the second inspection where Mr and Mrs Lingham have been required to ensure that appropriate heating is supplied for service users. Mr and Mrs Lingham have been asked to review the quality of care at the home and maintain communication with this Commission regarding developments and progress at the home. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 6 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 D52-D04 S39204 St Anthonys V217732 140405 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 D52-D04 S39204 St Anthonys V217732 140405 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, 3 and 4. The registered person has provided a statement of purpose and service users guide that details the facilities and services available within the home. The registered manager will assess all prospective service users prior to admission to ensure that the home can meet their care needs. The home does not admit service users referred solely for intermediate care. EVIDENCE: Since the previous inspection the registered person has complied with a requirement to provide existing and prospective service users with the guide. Samples of service users records were inspected and detailed assessments are available. The inspector met the majority of service users who expressed approval that their care needs are met. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8. The registered manager has provided assessment details for each service user and care staff record relevant details of care provided to service users. Although evidence was found that service users are accessing appropriate health care services, the registered manager is not recording a care plan that provides the individual basis for the care to be delivered and details of the action which needs to be taken to ensure that all aspects of the health, personal and social care needs of the service user are met. EVIDENCE: The registered manager is providing the Standex recording procedures for each service user. It was noted that the care planning section of this system was not included. The registered manager and senior care staff located the appropriate records and agreed to provide care plans with regard to the criteria of standard 7. The registered manager is responsible for the day-to-day organisation of the home and must demonstrate this by providing these details for less experienced care staff. Service users are registered with GP’s at Dean Street and The Parade surgeries; the inspector met the visiting community nurse and saw the chiropodist at the home. Discussion occurred with service users and staff to gauge dependency levels, needs and services provided. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 10 St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Service users exercise their choice to enjoy the privacy of their own rooms or join other service users in communal areas for company or meals. Service users maintain contact with visiting relatives and friends at the home. Service users are predominantly dependent on these contacts to access community facilities and the registered manager will organise occasional visiting entertainers and group activities at the home. The meals provided in the home are good with special diets and choice catered for. EVIDENCE: Service users were met in communal areas or their own rooms. Service users bring items of furniture and possessions such as televisions, radios and CD players. A service user expressed pleasure that regular visits are received from her son. The opportunity to meet visiting relatives did not occur but records of visits are maintained. The details of service users social profile, interests and activity should be recorded in the care plan, to demonstrate how opportunities for stimulation and choice of activity are provided for all service users. A discussion took place with the cook on duty to inspect the catering arrangements. The main meal of the day was observed to be nutritious and appetising. A separate vegetarian meal was provided and the cook had prepared home made cakes suitable for a service user with diabetes. Service users expressed approval of the catering services provided. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 12 St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The registered person has ensured that a complaints procedure has been issued to service users in the service users guide. The opportunity for the registered person and staff to attend training in this area would assist in the development of robust procedures to ensure the safety and protection of service users is maintained. EVIDENCE: The registered person has policy and procedures for the protection of vulnerable adults. The inspector discussed procedural issues with regard to recent events and the opportunity to attend the ‘No Secrets’ adult protection training provided by the social services is recommended. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 14 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, 21, 22, 23 and 25. The new replacement stair lift reaches the last 2 steps at ground floor level and service users accommodated on the first floor stated this improved facility assisted their mobility to move between floor levels. The registered persons have redecorated and invested in a bath hoist for the first floor bathroom, it is not acceptable that this bathroom has been unavailable to service users for over 12 months. Service users will live in a safer and more comfortable environment when the gradual introduction of radiator covers and regulators to all hot water outlets has been completed. The registered persons must ensure that the heating supply is switched on to enable service users to individually control the provision of central heating in their rooms and communal areas. The registered persons should demonstrate their priorities regarding a possible extension, health and safety issues, maintenance and issues regarding the use of service users facilities, in a development plan that is shared with service users, relatives, staff and the Commission. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 15 EVIDENCE: Service users were able to express their opinions in the privacy of their rooms. 12 service users are currently accommodated in 11 singles and 1 double room that is occupied as a single. 3 rooms offer en-suite facilities. The service users were seen to live in comfortable rooms that are individually decorated and personalised. Service users were observed to use the stair lift. Since the last inspection the registered persons have provided an assurance that the first floor bathroom would be available to service users before 31.1.05. and this timescale has not been met. The registered person stated that this work could be completed in a couple of days. A heating source will be required for this area. Since the last inspection the registered person has provided radiator covers in room 18 and in the corridor adjacent to this room. The registered persons have submitted an action plan that states the gradual completion of this programme will be completed before 31.12.05. Since the last inspection the registered person has provided an additional hot water regulator to room 1 and the action plan states that the gradual completion of this programme to all hot water outlets will be completed before 1.4.06. The previous inspection in November 2004, discovered that a timing switch was used to limit the central heating supply, which was unacceptable for service users welfare. A requirement was made to ensure the central heating was on throughout the day. During this unannounced inspection the heating supply was again found to be inappropriately set. The registered persons have a private area within the home, with no bedroom or bathroom. The registered persons use a shower and toilet within the first floor bathroom that is part of the registered facilities for service users. The registered persons sleep in a caravan parked in the car park at the front of the house. The registered person stated that the fire alarm is connected to the caravan and on call arrangements exist at night from this caravan. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 16 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 and 30. Staffing levels are appropriate to meet the needs of service users. The staff team is stable with some recent recruitment. Induction training and other staff training opportunities are provided to ensure a competent workforce is provided. The registered person must ensure that all staff or volunteers entering the home with access to service users are CRB checked, to provide for the welfare of service users. EVIDENCE: The unannounced inspection showed appropriate staff numbers and skills mix available to provide for service users welfare. Staff training opportunities are provided and staff have either completed or are registered at NVQ level 2,3 and 4. Since the previous inspection the registered persons have complied with a requirement to clarify on the rota, Mrs Lingham’ s time spent at the home in the capacity as registered manager. The registered person discussed the arrangement where the partner of the deputy manager may assist her in moving and handling duties, when they are responsible and on call, in the absence of the registered persons. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 17 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) 31,33 and 38. The registered manager is experienced and working towards the completion of the Registered Managers Award. The registered persons have consulted with appropriate agencies and provide a safe environment for service users. The registered persons could demonstrate clearer leadership through robust care planning procedures, more regular staff and service user meetings and providing monthly management reports to the Commission. EVIDENCE: Mr and Mrs Lingham are the directors of the company and Mrs Lingham is also the registered manager. Mrs Lingham registered with the RMA on 6.10.04. The registered manager should take a lead role in creating care plans at the home. The previous staff and service user meetings were discussed with the registered person. The registered person has only provided one monthly report received by the Commission on 19/1/05. The regular monthly supply of these reports to the Commission would improve communication regarding developments and ensure compliance with requirements. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 18 Since the last inspection the registered person has complied with a requirement to consult the Fire Officer. Records concerning various health and safety checks and maintenance were available for inspection. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 19 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 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 2 3 3 x 1 x STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 2 x x x x 3 St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 20 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 7 Regulation 15 Requirement A service user plan of care generated from comprehensive assessments must be drawn up with each service user and provides the basis for the care to be delivered. Toilet, washing and bathing facilities must be provided to meet the needs of service users. Timescale of 31.1.05. not met. The registered person must ensure that central heating is provided and that service users may control this heating in their rooms and communal areas. Timescale previously agreed of immediate action not met. The registered person must ensure the recruitment and selection process for any volunteers involved in the home is thorough and includes police checks. Timescale for action 31/7/05 2. 21 23(j) 31/5/05 3. 25 23(p) 31/5/05 4. 27 19 31/5/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 21 No. 1. 2. Refer to Standard 12 18 Good Practice Recommendations Service users interests should be recorded and given opportunities for stimulation through leisure and recreational activities. The registered person should contact local social services to arrange POVA training and ensure that robust procedures are carried out to respond to suspicion or evidence of abuse or neglect towards service users. The registered person should review the quality of care provided at the home and developmments occurring for improvements. A copy of this report should be supplied to the Commission and made available to service users. The registered person should provide monthly regulation 26 reports to the Commission. 3. 19 4. 33 St Anthonys D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell PL25 4AD 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 D52-D04 S39204 St Anthonys V217732 140405 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!