Inspection on 20/06/07 for The Anchorage

This inspection was carried out on 20th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Anchorage 07/02/06

The Anchorage 03/11/05

The Anchorage 18/01/05

The Anchorage 17/08/04

The Anchorage 02/03/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE The Anchorage Rutland Street Grimsby North East Lincs DN32 7RS Lead Inspector Ms Matun Wawryk Key Unannounced Inspection 20th June 2007 09:00 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 The Anchorage DS0000002770.V308443.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. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Anchorage Address Rutland Street Grimsby North East Lincs DN32 7RS 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) 01472 250817 manager.theanchorage@hica-uk.com Humberside Independent Care Association Limited Mrs Kay Ling Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40), of places Physical disability (25), Physical disability over 65 years of age (40) The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: The Anchorage Care Home is one of several in the Grimsby area owned by the, ‘not for profit’ organisation, HICA, based in Hull. It is registered for the care of 40 residents with nursing and residential care needs. The categories of care include dementia, physical disabilities and problems associated with old age. It is purpose built and provides accommodation on two floors; access to the upper floor is via stairs or a passenger lift. All rooms are for single occupancy, have en-suite facilities and are decorated to a good standard. In addition residents have access to four lounges, one of which is a designated smokers lounge, and a large dining room. The home has four bathrooms, two of which have specialised baths and two shower rooms. There are sufficient toilets strategically placed throughout the home. The grounds are secure and easily accessible. The home is situated close to the town centre of Grimsby and near to local shops, amenities and bus routes. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the main entrance hall of the home. Information given by the manager in the pre inspection questionnaire states the home charges between £329 and £495 per week. The home also charges third party top-up fees. In addition service users are expected to pay for hairdressing, private chiropody treatments, toiletries and newspapers/magazines. More up to date information on fees and charges can be obtained from the manager of the home. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the homes first key inspection of 2007/08. The inspection visit took place over 1 day in June 2007, Mrs Matun Wawryk carried out the visit. Prior to visiting the home the inspector sent out survey questionnaires to a number of residents, relatives and professional staff to try and establish whether the residents’ needs were being met. Three residents, two relatives and three healthcare professionals returned a questionnaire at the time this report was written. Some of the comments received by these people have been included in this report. During the visit the inspector spoke to seven residents, two relatives, two nurses, the administrator, a senior personal carer, three care workers, the activity coordinator and a visiting community nurse to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector also looked around the home and looked at lots of records, for example; resident care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. What the service does well: There was a very relaxed and homely atmosphere in the home, residents were observed to be very settled and comfortable in their surroundings. The home was clean and tidy and domestic staff work hard to maintain the high standards. Residents spoken to were happy with the cleanliness of their bedrooms and the home in general. All of the residents who returned a questionnaire and those spoken to said they were satisfied with the overall care provided by the home. Residents were complimentary about the staff team stating they were kind and caring and supported them well. Some staff had been at the home for many years and they provided consistent care but there had been a lot of staff changes over the last twelve months. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 6 Residents and relatives spoken to during the visit told the inspector that they had chosen the home for reasons such as: the friendly atmosphere, the facilities/ location and the kindness and friendliness shown by the staff. Residents said they had good access to professional medical support when needed. Residents also said that they were able to access external services such as chiropodist and opticians as needed. One visiting nurse said ‘ the staff are very good, they act on advice given and always ensure appropriate dressing are obtained for the person’ Residents commented that they were offered a good choice of meals and that they enjoyed the quality of food. Specific wishes were catered for and residents said they had plenty to eat and drink throughout the day. Comments from residents included ‘excellent food’, the food is lovely’. Residents said that their family and friends were made to feel welcome by staff when visiting the home and that they can visit when they please. What has improved since the last inspection? What they could do better: Although the medication was generally managed well some omissions were noted on some residents medication administration records and this raised questions about whether medication had been given. Staff were also not always following best practice when handwriting medication onto peoples medication records. All the staff were receiving one to one supervision from the manager or named supervisor but this was not happening as often as it needs to for some staff. Some staff needed to be provided with more regular, formal support to ensure they are provided with the appropriate guidance and leadership they need and to receive management feedback on their performance. The home employs an activity co-ordinator who normally works 10 till 2 pm Monday to Friday. This person organises most of the activities, which take place in the home. Examination of a sample of records showed limited take-up of activities by some residents. There was also limited evidence to show how the social needs of more dependent residents were being met. The activity coordinator said plans were in place to review the activity programme. It is important that this happens and that a broader programme is developed with residents taking into account their interests and abilities so that all the residents have the opportunity to be involved in meaningful activities of their choice and within their capabilities. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 7 The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this inspection. Your comments and input have been a valuable source of information, which has helped inform this report 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. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 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 The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The admission process was thorough with staff ensuring that new residents are made to feel welcome and secure. Information about fees and charges is made available at an early stage, this means people have access to all the information they need to make informed decisions about the homes capacity to meet their needs. EVIDENCE: Three care files were examined in detail and two others perused for specific issues during the inspection and it was clear that the manager ensured The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 10 assessments of need prior to admission were completed and that staff obtained copies of assessments/care plans completed by care management. This enabled them to decide whether the person needs could be met within the home and to develop a care plan to meet the persons needs. There was no evidence in the files to show that the manager formally wrote to people or their representatives following assessment to confirm the home was able to meet the needs of the person, this should now happen for new admissions. There was evidence that residents were issued with a contract of terms and conditions. The home charges top-ups for residents whose care is publically funded, the administrator gave an assurance that this was always paid by a third party. Some people spoken to were aware that an assessment of their needs had taken place and that a care plan had been formulated to meet their needs. Residents at the home who received nursing care had had an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual and to determine the amount of financial support they would receive. There was good evidence to demonstrate that nursing and care staff were accessing a range of service specific training which will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. Information given by residents and staff indicated that there was sufficient equipment within the home to meet a range of needs, although two staff commented that a third mobile hoist was needed. Specialist equipment was obtained via district nursing services as required. Staff in interview confirmed that they understood the admission process and were aware of the importance of ensuring new residents were made to feel welcome. Residents and relatives spoken to during the visit told the inspector that they had chosen the home for reasons such as: the friendly atmosphere, the location and the friendliness shown by the staff. One individual spoken to said ‘ I was brought here by my family to see the home and talk to the staff before I made the decision to stay’. One relative told the inspector that her mother had ‘settled into the home very well’, she visits the home regularly and said she always found the staff to be polite and friendly’. Another relative said ‘expensive but worth every penny’. One relative wrote in their survey ‘good standards of cleanliness, nurses and staff friendly and supportive’. Residents are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home had two male carers as well as female carers. The nurse in charge said this matter was discussed with people during the assessment and care planning process. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 11 Information from the Pre-Inspection Questionnaire completed in September 2006 and discussion with the staff and observation on the day indicates that with one exception all the residents living in the home are white/British. The nurse in charge said staff would be able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary additional training and guidance would be provided to staff to enable them to be responsive to the resident’s needs. The home does not accept intermediate care placements so standard six does not apply to this home. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,9 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs were well met; the care plans were generally well developed and took account of the person’s needs and preferences. The medication systems are generally well managed but some improvement in recording practice is needed to ensure peoples health needs are managed well and consistently. EVIDENCE: The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 13 Case tracking took place for four residents. The methodology used was a physical examination of care plans; written surveys to resident’s, health and social care professionals and direct observation on the day. Care plans examined indicated that the needs highlighted in assessments were generally planned for. Care plans were updated as needs changed and evaluated on a monthly basis. There was evidence that some people had signed agreement to their care plans and individual plans referred to levels of independence, privacy and dignity in most cases. Some people spoken to knew they had care plans, whilst others said they had no interest in reading their individual plans. From discussions with residents and examination of documentation it was evident that people were supported in personal care tasks by staff that respected their privacy and dignity. Risks were identified in relation to nutrition, pressure sores, moving and handling. There was evidence of professional input from dieticians, community psychiatric nurses and district nurses and all the residents were registered with a GP. There was evidence that residents were weighed regularly. The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. Care plans and risk assessments for people with pressure areas were in place and specialist equipment specialist beds, mattresses and seat cushions. Three health care professionals returned a questionnaire. One CPN wrote in their survey ‘Although I have not been in the home for 18 months, they have in the past shown the ability to manage clients with quite complex needs. A speech and language therapist wrote ‘they appear to have more understanding of dysphasia and management than most residential/nursing homes. Another health professional wrote ‘when I am called to see service users I have found that documentation relating to wound management is either non existent or of poor quality. Sometimes this has been resolved at subsequent visits, however I have not as yet seen good documentation/instruction in pressure area care & wound management’. Staff were monitoring the fluid in put and out put of some residents and examination of a sample of charts showed staff were recording when fluids had been given, however there was no evidence to show how the information was analysed. It is good practice for staff to monitor fluids intake where there are concerns and staff are to be commended for this. However it is equally important that information gathered is analysed and if necessary further action is taken to address matters noted. The home uses a Monitored Dosage System for medication and only nurses administer medication. Medication systems were examined; policies and The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 14 procedures were in place, which covered all areas of management. Temperature recordings of the refrigerator were taken daily and were satisfactory. A signature list of staff authorised to administer medication was present. Generally medication was being managed appropriately however there were a number of areas where improvement was needed. Staff were sometimes handwriting medication (transcribing) on to the medication administration record (MAR), a second member of staff was not witnessing the entry to confirm the information was correct. In order to ensure proper safeguards are in place a second member of staff should witness all hand written annotations on the MAR. There were some omissions of signatures or codes in the administration records and this raises questions about whether medication has been administered or not. Staff were not always signing the MAR to confirm quantities of medication received into the home. It is important that staff fully complete the MAR record to ensure the safety of residents. Staff were not always recoding on the medication record sheet when topical creams had been applied. Care staff mainly applied the creams when getting residents up etc or when helping with other personal care tasks. Care staff then record in the persons care records when creams have been applied. Examination of a sample of records showed some gaps in recording. It is important that records are consistently maintained. Staff were administering medication via people PEGs, the MAR sheet did not detail the route that medication is to be given in all cases. Records did not set out that each medication must be given separately, unless otherwise agreed and did not set out flushes between medication administrations. Detailed records of the batch numbers of feeds for residents with PEG tubes fitted had also not been kept. Peoples PEG regimes must be revised to reflect these matters to ensure their health and safety. Controlled Drugs in current use were stored in a controlled drugs cabinet and an appropriate register was in use. The quantities of controlled drugs in stock matched the balances recorded in the register. Others areas of medication management in relation to receipt, storage and stock control were appropriate and effective. Residents spoken to confirmed that care was provided in a way that respected privacy and dignity. The inspector observed staff speaking to residents in an appropriate and caring way. Analysis of the surveys received together with discussions during the visit identified that everyone was very satisfied with the quality of care provided at the home and the attitude of the staff; comments included “ I have been very The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 15 impressed with the carers at The Anchorage, ‘I have appreciated their kindness and concern towards my mother and myself” and “The entire staff are most cheerful, helpful and informative and work as a team, this creates a lovely atmosphere.” The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are enabled to keep in contact with family and friends and residents receive a healthy, varied diet according to their assessed needs and choices. Residents have access to recreational and social activities, but further improvement in this area is needed. EVIDENCE: Staff said the routines of the home are planned around the resident’s needs and wishes. All the residents spoken to said that they felt staff listened to them and said they were able to exercise choice in aspects of their life and daily routines. In discussion staff displayed a good knowledge of individual The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 17 resident’s needs, likes/ dislikes, family support and records contained information about people’s religious observances. Choices and preferences were generally indicated in assessments and care plans and people spoken to confirmed that their wishes were adhered to regarding times of rising and retiring, preferences with bathing arrangement, personalising their bedrooms and general choices about meals and gender of carer. Residents confirmed that they are able to choose how to spend their day, what clothes to wear and which visitors to receive. Residents said their family and friends were made to feel very welcome when visiting the home. This was confirmed in discussions with two relatives. Relatives said there were no restrictions on visiting times The home employs an activity co-ordinator who normally works 10 till 2 pm Monday to Friday. This person organises most of the activities, which take place in the home. An individual activity record is maintained in each residents care file, examination of a sample of records showed limited take-up of activities by some residents. There was limited evidence to show how the social needs of more dependent residents were being met. Residents’ social and psychological needs were identified in care records, however in most cases these were very brief. One relative spoken to said ‘perhaps could be a little more OT’. Four of the residents spoken to said they were happy with the level of activities provided, one person said they ‘sometimes get bored’. Two people were unable to express an opinion about activities on offer in the home. The home provides three meals a day and a light supper. The nurse in charge said there were no restrictions on what food could be ordered. Staff were seen to assist residents sensitively and encouragement and supervision was provided where required. Most of the residents spoken to said the home provided a good standard of meals. Comments included I like my food here in the home’, ‘I enjoy all my food, I get what I want’, ‘I am completely satisfied with the meals’, ‘the quality of the food depends on which cook is on’ ‘Not enough choice, same each week’. The home caters for people on low fat, diabetic and fortified diets as well as people who had a ‘PEG’s’ fitted. The nurse in charge said other specific dietary needs would be accommodated where this was needed. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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. A satisfactory complaints system was in place and residents and staff can be assured complaints and concerns will be listened to and acted upon. A safeguarding procedure was in place and staff had received training in the protection of vulnerable adults. EVIDENCE: One complaint about the home has been referred to the Commission since the last inspection carried out in June 2006. Information in the pre inspection questionnaire indicated the manger had received three complaints since the last inspection. Three complaints were unsubstantiated and one was partially substantiated. A complaints procedure was in place and staff spoken to said they had no complaints about the home and felt confident to raise issues of concern if they arose with the manager. Five of the seven residents spoken to confirmed that they knew who to report concerns or complaints to. Two residents who had memory impairment The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 19 problems were unable to say whom they would speak to if they had any concerns. Two visiting relatives were spoken to and both said they were aware of the complaints process. All the residents who returned a questionnaire said they were aware of the complaints procedure. Information from the Pre-Inspection Questionnaire and discussion with the nurse in charge indicates the home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing and management of resident’s money and financial affairs. Residents spoken to said they felt ‘safe’ in the home. When asked about abuse, what it was and what they would do if they suspected or saw or suspected any abuse staff stated that they would report it to the manager or nurse in charge. Examination of a sample of individual staff training records showed staff had been provided with training in safeguarding adults. Staff interviewed also had a good knowledge of whistle blowing procedures. Since the last inspection one adult protection referral had been made to the local authority, staff at the home had dealt with this matter appropriately. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with a warm and comfortable environment that is homely and welcoming EVIDENCE: The home provides and maintains comfortable and clean facilities. All areas of the home were generally decorated and furbished to a good standard although decoration and soft furnishings in some rooms is old and dated. Information in the pre-inspection questionnaire indicated the home complies with the requirements of the local fire and environmental health department. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 21 The communal areas were all well utilised during the visit; residents spoken to commented on how happy and settled they were at the home. An up stairs bathroom needed refurbishment; a requirement concerning this has not been made because staff gave an assurance that work on the bathroom was going to take place within the next few weeks. All bedrooms seen were clean and tidy and were furnished and decorated in a homely style. Many people had furnished their bedrooms with a range of personal items, some bringing in items of furniture to reflect their own individual choice and taste. All the residents who were able to express an opinion said they were happy with their rooms. Policies and procedures for the control of infection were in place and staff in interview confirmed a good understanding of infection control measures and confirmed adequate supplies of protective clothing. Equipment provision was also discussed with the staff. Staff said the home was generally well equipped although two staff commented that they felt they and the residents would benefit from a third hoist. The home is built on two floors with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Access to the upper floor is by use of a staircase and passenger lift. The location of laundry facilities is suitable and ensures that dirty laundry is not carried through food storage, preparation or dinning areas, it is fitted with industrial washers and driers. There is separate hand washing facilities in the laundry room and floor covering is impermeable and easily cleaned thus eliminating the risk of cross infection to the residents. Residents and relatives spoken said they had not experienced any particular problems with their laundry, and all said cloths were washed and ironed appropriately. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are well trained and competent to carry out their work. EVIDENCE: The roles and responsibilities of staff are clearly defined and in discussion with the inspector staff demonstrated understanding of the management and reporting structures for the home. There were thirty-nine people were living in the home at the time of the visit. At the time of the visit the home had almost 100 care workers hours vacant. Recruitment to these posts had been carried out and it was anticipated people would be in post within the next couple of weeks. To cover this shortfall existing staff were working overtime and agency staff were being used to fill gaps in the rota. A pre inspection questionnaire detailing staffing hours and dependency levels of residents had been sent to the commission in September 2006. However because of the timing on this inspection this information was out of date. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 23 Information in the pre-inspection questionnaire stated that there were five residents with high needs. Information given by the nurses at the visit indicates dependency levels have increased, for example; nine current residents had high need nursing determinations, two people were receiving continuing care funding, staff said one of these people would be high need had they not been receiving this level of funding. The nursing staff were unable to confirm the dependency levels of people receiving non-nursing care. Because of this the inspector was unable to assess the adequacy of staffing within the home. It is important that full and accurate information is available about people dependcancy levels and that this be reflected in people’s assessments and individuals plans. This will ensure accurate assessments and judgements can be made about staffing needs. Evidence from discussions with residents during the visit confirmed that they were satisfied that the care they received met their needs and how kind and supportive the staff were. One person said ‘I’m very happy in the home, the staff are very nice and always helpful’. Another person said ‘Staff always make time to talk to you’. Two of the seven resident’s spoken to said the staff were very busy, and they said people sometimes had to wait for their call bells to be answered. One resident said ‘‘staff are sometimes unable to attend straight away, due to other residents needs’ ‘sometimes short staffed’, there have been a lot of agency staff working in the home of late’. Observation of the staff showed that the home is busy, but well organised. In interview, staff said staffing levels were generally satisfactory and confirmed that they were able to complete essential care tasks, but some said they had limited opportunity to spend one to one time with residents. The home remains committed to providing National Vocational Qualification training for staff. The pre inspection questionnaire indicates 34 of care staff are now trained at level 2 or above; which is a positive achievement and a number of other staff had been enrolled to complete an award. The service had a recruitment policy and procedure to ensure that staff employed were safe to work with the people living in the home. The inspector was not able to check application of recruitment polices because the manger was on training on the day of the inspection and staff on duty did not have access to the records. Previous inspection findings have not highlighted any problems with the way new staff are recruited and selected. An equal opportunities policy and procedure is in place and feedback from the nurse in charge, staff and information in records showed the procedure is followed throughout the homes working practices and staffs access to training. New staff are required to complete a five- day block induction, which included training in fire safety, safeguarding vulnerable people from abuse, moving and handling and other core training and that staff also had to complete a The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 24 ‘workbook’. The Nurses said the induction complies with Skills for Care Common Induction Standards specification and includes a competency assessment in care practices. The inspector was unable to verify this because staff could not locate any workbooks. One recently employed worker described their induction as ‘very thorough’. The home offers staff a wide range of training aimed at meeting the needs of the residents. A training plan to incorporate mandatory training and updates was also in place. Examination of a sample of staff training records showed the majority of staff had completed fire safety, food hygiene and moving and handling and further training was planned. The majority of staff spoken to said ‘ HICA offers staff excellent training opportunities’. Other staff said ‘they were encouraged to attend ‘any training which would benefit people living in the home’. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A competent and experienced manager manages the home and the manager reviews aspects of the homes performance through a regular programme of audits and consultations. Resident’s safety was generally well promoted and protected. EVIDENCE: The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 26 The manager is a qualified nurse and has many years experience of working residential care. Staff confirmed that moral was good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews indicated that staff consider the manager and senior staff to be very approachable. Staff said they take issues raised seriously and take prompt action to resolve matters where this is needed. The provider organisation has developed robust systems for quality assuring its services including regular audit and surveys of residents, their relatives, staff and other key stakeholders and inspection of these confirmed that they were generally being maintained well and kept up to date. During 2007 two newsletters had been issued to people. The most recent newsletter gave information about recent quality monitoring arrangements. Checks of the financial systems found that these are computerised, up to date and maintained on a daily basis by the administrator of the home. The home only keeps a limited amount of money within the home; surplus monies are kept in a communal resident account, which does not pay individuals any interest. The inspector did not check whether this information is put into the Service User Guide so all those coming into the home are aware of the homes arrangements. A sample of records were checked and these were found to be in good order. A staff supervision programme was in place and all staff had a named supervisor. Examination of a number of the records evidenced that not all the care staff had accessed the required amount of sessions (six) within twelve months. Action must now be taken to address this. Information gathered from the pre-inspection questionnaire indicated that there are a range of policies and procedures in place for health and safety. Safe working practices are maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, basic first aid, infection control and fire safety. Training records evidenced that the majority of staff had received this training and further training was planned. Information in the pre-inspection questionnaire also indicated that maintenance certificates were in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. The manager had completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling and daily activities of living. The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 27 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 29 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 The registered person must ensure that all medication is signed for consistently after administration and ensure application of prescribed creams is consistently recorded, in order to ensure that the health needs of residents are appropriately met. The registered person must ensure the MAR sheet for residents who have their Medication administered via their ‘PEG ’ details the route that medication is to be given in all cases. Records must set out that each medication must be given separately, unless otherwise agreed and must detail flushes (amounts) between each medication administration. Detailed records of the batch numbers of feeds for residents with PEG tubes fitted must also be kept. Peoples ‘PEG’ regimes must be revised to reflect these matters to ensure their health and safety. 3 OP12 16(2)(m)( n) The registered person must ensure that an activities plan is developed with the residents DS0000002770.V308443.R01.S.doc Timescale for action 30/07/07 2 OP9 13 31/07/07 30/11/07 The Anchorage Version 5.2 Page 30 4 OP36 18(2) taking into account their interests and abilities so that residents have the opportunity to be involved in meaningful activities of their choice and within their capabilities. The registered person must 31/10/07 ensure that all staff receive regular documented supervision at least six times year. This is needed to ensure staff are provided with the appropriate guidance and leadership they need and to ensure they receive regular management feedback on their performance. 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 OP28 OP9 Good Practice Recommendations 50 of the care staff should be trained to NVQ level 2 The registered person should ensure a second member of staff should witness all hand written annotations on Medication Administration Record charts. The registered person should ensure that complete and accurate information is available about people’s dependency levels and that this be reflected in people’s assessments and individuals plans. This will ensure accurate assessments and judgements can be made about staffing needs 3 OP27 The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Anchorage DS0000002770.V308443.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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