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Inspection on 18/09/06 for The Anchorage Rest Home

Also see our care home review for The Anchorage Rest Home for more information

This inspection was carried out on 18th September 2006.

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.

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

There is a stable management and staff team in place, which contributes to a consistency in care and support for residents. There are good systems in place to help ensure that the resident`s care and health needs are being met. There are good catering arrangements in place, which provides choice and is able to meet the resident`s dietary needs and preferences. Food is freshly cooked, presented well, and is enjoyed by the residents. The premises are decorated, furnished and maintained to a good standard, and provide a comfortable and homely environment for residents. The grounds are well maintained, and the gardens are attractively laid out. There is a good atmosphere in the home.

What has improved since the last inspection?

The medication system has been updated, and it is anticipated that this will provide a better and safer way of administering medicines in the home. Staff supervision is being more regularly provided, and the recommendation on this made at the previous inspection is now assessed as met.

CARE HOMES FOR OLDER PEOPLE The Anchorage Rest Home Coombelands Lane Pulborough West Sussex RH20 1AG Lead Inspector Unannounced Inspection 18th September 2006 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 Rest Home DS0000014767.V301049.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 Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Anchorage Rest Home Address Coombelands Lane Pulborough West Sussex RH20 1AG 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) 01798 872779 Rhymecare Limited Mrs Sheila Marion Wyatt Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: The Anchorage is a Care Home registered to accommodate up to thirty service users in the category of older persons over the age of 65 years, not falling within any other category. The property is detached and is situated near Pulborough in West Sussex. Accommodation is provided on ground and first floor levels, and there is a passenger lift. The registered provider is Rhymecare Limited, for whom the responsible individual is Mr Nick Wyatt. The registered manager is Mrs Sheila Wyatt. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was arranged to provide an assessment of how the service is performing against the key National Minimum Standards (NMS) for care homes for older people. The inspector was on the premises for six hours, and talked with residents, care staff and catering staff, and the registered manager. The inspector sampled five sets of admission and care plan records, and three sets of staff recruitment and training records. A partial tour was made of the premises, and a staff handover meeting was attended. Pre-inspection information provided by the home has also been included in the writing of the report. The inspector would like to thank everyone who contributed to the inspection. What the service does well: What has improved since the last inspection? The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 6 The medication system has been updated, and it is anticipated that this will provide a better and safer way of administering medicines in the home. Staff supervision is being more regularly provided, and the recommendation on this made at the previous inspection is now assessed as met. 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 Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5. 6 Arrangements are in place for the proper assessment of residents prior to admission, and for potential residents to visit the home or have trial stays before admission. The home does not provide intermediate care. The outcomes for residents were found to be good. EVIDENCE: The registered manager has advised the Commission that fees are £450 to £475 per week. The inspector sampled admission records for five residents who have been admitted since the previous inspection, and found these to be in good order. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 9 Records seen included dates of introductory or respite visits that had taken place previous to admission. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Care plans are in place to ensure staff have guidance on how the individual resident’s needs should be met, and these care plans are being regularly updated. Residents are able to access the health care services they are in need of. The outcomes for residents were seen as good. EVIDENCE: Five sets of care plans were sampled. Care plans are being reviewed each month, and include general guidance to staff on the care which needs to be provided for the individual resident. Each resident has a named key worker, and care staff interviewed gave examples of the individual support which is provided by the key worker. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 11 The inspector attended a staff handover meeting where the individual needs of residents were being discussed and updated. Care records seen indicated that residents are accessing the health care services which they need, including chiropody, hearing and visual aids, and are receiving support for medical conditions. For example, district nurses were in attendance on the day of the inspection, and were observed by the inspector to have good communication and understanding with the staff team. The care home have updated their medication systems, which has been assisted by the contracted pharmacist for the home. Staff have received training in the new system, and the new system is expected to be more efficient and more safe to use. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Routines in the home are reasonably flexible, and the quality of meals provided is good. Staff are seeking to increase the number of activities and entertainments provided in the home. The outcomes for residents were seen as good. EVIDENCE: The registered manager has advised that events provided include a clothes show, a book club, an annual garden party, and theme lunches. In the community, a local lunch club and an afternoon club take place which some residents attend. Routines in the home were found to be reasonably flexible – for example, on the day of the inspection staff were discussing that a resident would prefer her baths on a different day, and this was being arranged. A list of theme days and events at the home were seen on the staff notice board, and future events planned include a bonfire party. Registered Manager The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 13 Mrs Wyatt said that some of the activities arranged in the past, such as an arts and crafts session, had not been successful, but the staff team were presently discussing ideas for new activities. Residents’ special dietary needs and food preferences are noted and followed by the catering team, and the chef showed the inspector how preferences and diets are being recorded. Residents have a choice of meals, and the individual resident’s choice is recorded on a sheet which is double checked by staff serving the meal. The inspector observed a lunch sitting, and talked to residents during the lunch. Residents were receiving assistance with meals if they needed it, and the meal was unhurried and taken in a relaxed atmosphere. Residents interviewed said the meals were very good, and the chef was praised. The meal served was well presented, and nutritious. Menus seen indicated that meals are varied and balanced. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 A complaints procedure is in place, and complaints are being investigated and responded to within the required time periods. The reporting of adult protection incidents needs to be improved, and advice to staff on reporting adult protection incidents needs to clearer. The outcomes for residents were seen as adequate. EVIDENCE: The complaints record seen indicated that 3 complaints have been received in the past 12 months. One was substantiated and one partly substantiated after investigation by the home, and all three complaints were responded to within 28 days. The inspector advised Mrs Wyatt that the outcomes of complaint investigations should be more fully recorded. The registered manager advises that, for the protection of residents, one previous member of staff has been referred to the Protection of Vulnerable Adults register, and a copy of this referral was seen. The adult protection procedure for the home has been updated, but was found not to provide sufficiently clear guidance for staff on which agencies should be contacted to report an adult protection incident. It was noted that there had been a delay in reporting an adult protection incident to the local social services team. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 15 The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 16 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): 19, 20, 21, 24, 26 There are good communal, bathroom and toilet facilities for residents. The gardens are accessible, attractive, and well maintained. The decoration and furnishing of bedrooms has been done to a good standard. The outcomes for residents were seen as good. EVIDENCE: A partial tour of the premises was made. 22 of the 30 bedrooms have en suite facilities, and all are single occupancy rooms. The kitchen was being extended at the time of the inspection visit, and when completed, this will provide more space for storage and kitchen preparation, reduce the number of care staff needing access to the kitchen, and improve kitchen safety. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 17 More shelves have been provided in the laundry room, which has appropriate facilities for soiled laundry. The gardens are accessible, attractively arranged, and well kept. All communal areas are decorated and furnished to a good standard. Communal and bedroom areas were found to provide a comfortable and homely environment for residents. There are plans for new dining room furniture when work on the kitchen area has been completed. Bathrooms have suitable equipment available to meet residents’ needs. There is a passenger lift which was operating well on the day of the inspection. All areas of the home visited were clean, hygienic and odour-free. All bedrooms visited were in a good state of repair, and were furnished and decorated to a good standard. Residents interviewed said they liked their bedrooms, and enjoyed using the garden. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29, 30 There is a settled and experienced staff team who are being employed in adequate numbers. Staff are being supported to do a good job by the supervision and training arrangements which are in place. The outcomes for residents were found to be good. EVIDENCE: There are 17 care staff, and one first level registered nurse. The provider has advised that 53 of care staff have NVQ at level 2 or above. Staff training in the past 12 months has included infection control, essential first aid, food hygiene, health and safety, moving and handling, and appointed persons’ first aid. The catering team are contracted to provide the meals service in the home, and the chef arranges for the training and employment of his catering team. While there have been some changes to the staff team since the previous inspection, the care staff team is very familiar to the residents, and have a variety of skills and experience to meet the needs of residents. The inspector The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 19 noted during the inspection that staff were courteous and friendly towards residents. Staff interviewed said that staff training and supervision had improved, and that team spirit was good. One member of staff said she was “happier than I’ve ever felt” at work, and another said that communication between staff was better and “we can talk to each other more”. Staff said that the manual handling and fire training had been of particular benefit, and one member of staff said that National Vocational Qualification in care (NVQ) training had “opened my eyes up”. Three sets of staff training records were sampled, and these indicated that staff were regularly undertaking training in core subjects, and were being offered the opportunity to undertake NVQ training. Staff said that that regular staff supervision (which had not been taking place at the time of the previous inspection) was helping the team come together and was helping improve communication. Staff discussed the advantages for residents of the key work system. Residents interviewed said they found staff helpful and approachable, and that things were done quickly. The inspector observed during the visit that call bells were being answered promptly. Staffing levels on the day of the inspection were found to be adequate to meet the care needs of the residents accommodated. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35, 38 The service is being well managed, which is contributing to good staff morale and a good level of care for residents. Arrangements are in place for the views of residents and others on the service to be sought, recorded, and considered. Arrangements are in place to ensure the health and safety of staff and residents, including training for staff in health and safety topics. The outcomes for residents were found to be good. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 21 EVIDENCE: Information was provided on the most recent services, inspections and checks carried out to ensure the safety of the premises and equipment in use. The report of an environmental health department visit which took place on 1.8.06 was seen, and this stated that there were good policies and procedures in place in the kitchen. The registered manager has advised that all residents’ financial matters are overseen by family or a solicitor, and not by the home. Mrs Wyatt advised that a policy is being drawn up for when residents wish staff members to purchase items or services on their behalf. Environmental risk assessments carried out by the home in May 2006, which included action taken, were sampled. These indicated that environmental hazards in the home are being identified and acted upon. The accident book for the home was seen. Staff training records seen indicated that staff were receiving training in health and safety topics such as food hygiene, moving and handling, and health and safety. A report of the most recent consultation with residents was seen, although this was not signed or dated and did not set out what action was planned to address some of the issues identified. The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 23 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 OP18 Regulation 13.6 Requirement Adult protection procedures should be signed and dated, and include advice on the referral of incidents to the local authority and to the referral of staff who have put residents at risk or harmed them to the Protection of Vulnerable Adults register Timescale for action 04/12/06 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 Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worthing LO 4th Floor, Overline House Blechynden Terrace Southampton Hampshire SO15 1GW 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 The Anchorage Rest Home DS0000014767.V301049.R01.S.doc Version 5.2 Page 25 - 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!