CARE HOMES FOR OLDER PEOPLE
The Anchorage Rutland Street Grimsby North East Lincs DN32 7RS Lead Inspector
George Skinn Unannounced Inspection 3rd November 2005 09:30 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.V262121.R01.S.doc Version 5.0 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.V262121.R01.S.doc Version 5.0 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 HICA Mrs Kay Ling Care Home 40 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (40), of places Physical disability (25), Physical disability over 65 years of age (25) The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th January 2005 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. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken over 4 hours and the home was measured against the National Minimum Standards for Older People. The home was looked at as were some records, and residents were spoken with. What the service does well: What has improved since the last inspection?
The home has complied with al the requirements from the previous inspection. This includes the homes records concerning the way the needs of the residents are met and the homes policies and procedures which the staff have to follow. These improvements mean that the staff are better able to care for the residents as the information kept guides them better. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 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 The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 & 11 Residents’ personal care needs are well met by the staff group. Medication is handled safely and staff are appropriately trained to ensure the safety of the residents. EVIDENCE: Each resident has a plan of care, which has been devised from the assessments; the resident or next of kin is involved in the formulation of these and subsequent reviews. The way in which the care plan recorded likes, dislikes, preferred routines demonstrated the residents had been consulted. A form has been devised which asks the resident where appropriate, or their relatives to acknowledge that they are aware and agree with the contents of the care plan a signed copy was seen on all those files inspected. Care plans set out in detail the action to be taken by staff; these are linked to individual risk assessments. Each care plan is reviewed on a daily, weekly and monthly basis. Risk assessments relating to falling, moving and handling are
The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 10 available. The documentation used is under review and some of the formatting has been changed and new documents introduced. Residents’ health care needs are met and staff ensure they have access to health care services to meet their assessed needs. Equipment is available for the promotion of tissue viability and the prevention of pressure sores. Residents’ dietary intake is monitored on both an informal and formal basis dependant on need, and concerns are referred to the local dietician for advice. There is a detailed medication policy in the home about the handling of medication. Records of medication received into the home are well maintained along with their administration and disposal. The home does not routinely facilitate self-medication. Those residents whom wish to self medicate would be enabled in this process, subject to an assessment and agreement. Appropriate storage facilities for controlled medication are available. Some medication is stored in a fridge; the temperature of this is monitored and recorded on a daily basis. Senior staff that have been trained and assessed as competent administer medication in the home and sample signatures are retained. The health of residents on medication is monitored and recorded in case files regular medication reviews takes place with the GP. The organisation has developed a medication-training package, which has extend to a formal assessment process based on competency and understanding The maintenance of residents’ privacy and dignity forms part of the staff induction programme. Residents spoken to confirmed that privacy and dignity is respected whilst personal tasks are being undertaken, assistance is always available but where possible independence is enabled. Medical examinations/ treatment is conducted in the privacy of the residents’ own room. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 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 the following standard(s): 15 Residents’ meals are wholesome and a balanced diet is provided. EVIDENCE: The quality of the meal was very good and the way in which it had been cooked had taken into account residents needs. The staff who are responsible for serving the meals know residents likes and dislikes. Residents spoke positively about the quality of the meals comments were: “the food is always nice” “You always get a good choice at every meal time”. Assistance is offered to residents with individual needs. Residents are offered a choice at each mealtime; the menu indicates that cooked alternatives are available at both lunchtime and teatime. Tables are set appropriately with clean tablecloths, serviettes, condiments etc. Once the meal is finished staff seek the views of residents about their meal. The mealtime was a very relaxed social occasion. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Both relatives and residents knew whom to complaint to and had confidence that their complaints would be taken seriously. The residents are protected from abuse. EVIDENCE: A complaints procedure is available which encourages residents and relatives to express their dissatisfaction without fear of repercussion. This procedure includes contact details for CSCI. Complaints are seen as an opportunity to improve the service as a whole or more specifically for an individual. Residents and relatives all said they felt the management style of the home encouraged them to speak out and they were satisfied that they would be listened to and issues acted on, they would not hesitate in bringing such matters to the staffs attention Residents are protected from abuse with robust procedures in place for responding to any suspicion. All staff receive formal training on abuse and the protection of vulnerable adults. The home does have a detailed system for the management of residents’ finances, which protects residents from financial abuse. The homes policies and procedures preclude staff from involvement in the making of wills or receiving gifts. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Residents live in well-maintained environment, which is clean, pleasant and hygienic. EVIDENCE: The home was purpose built and is accessible, safe and well maintained. The maintenance of the building is audited by the home manager as well as the company bank to ensure environmental standards do not deteriorate. Redecoration is ongoing and subject to individual choice. Small garden areas are available and used by residents. The building complies with the requirements of the local fire and environmental health department. CCTV cameras are not used. The premises were clean and hygienic with systems in place to reduce the risk of odours. It is the organisation policy that where minor odours are identified as a problem that cannot be rectified by cleaning then new carpets are purchased.
The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 14 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 if cross infection to the residents. Policies and procedures for the control of infection are in place along with the provision of protective clothing, again to eliminate the risk of cross infection. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 & 38 Residents live in a home which is well managed and has effective administrative procedures to ensure that their health, safety and welfare is protected. Residents’ benefit from a well supervised staff group. EVIDENCE: Staff now received the required amount of supervision over a twelve month period. The home has a detailed Health and Safety policy. Safe working practices are maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, first aid at work, basic first aid, infection control and fire safety. Systems are in place to ensure that all the homes equipment and building maintenance is up to date. Hazard notifications are circulated to the home
The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 17 manager, action taken and then retained for staff to see. Hot water is regulated to control the risks of Legionella along with the risk of scalding. The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 3 x 3 The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Anchorage DS0000002770.V262121.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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