Care Home: Anchor Lodge

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What the care home does well Relatives were extremely complimentary about the standards of care and told us how supportive staff were at helping residents adjust to the sometimes difficult transition to residential care. They also told us how the health of a number of residents had been considerably improved since admission. One relative told us "The home is very informal, which I like. The staff have a good attitude and compassion towards the residents. The care is good and staff have a genuine interest in each resident". Another relative said "I couldn`t say a bad thing about the home. I`ve had no regrets since they were admitted, it`s a terrific place". One of the relatives told the expert by experience "There is honestly nothing I would like to change, the care here is wonderful. They are treated like an individual, not just an old person". A resident told us "I can`t find any fault with the home. The food is good and they look after you when you`re unwell. I don`t think they could do any better". The expert by experience said "The manager`s knowledge of residents` family history, interests and hobbies was very impressive, and showed me what an interest she takes in each person`s individual life and circumstances. She clearly does all she can to give her residents a good quality of life, and values them all as individuals". What has improved since the last inspection? The dining room furniture had been replaced so that there were now sufficient places for the number of residents in the home. However the room was very small and the manager told us that they would be having two sittings at mealtimes in future, in order to accommodate residents more comfortably and allow staff space to give them assistance when necessary. Three residents` bedrooms had been decorated and refurbished. The laundry had a new floor and tiled walls and it was now possible to keep the room in a clean and hygienic condition. Radiators had been covered and the water temperatures had been adjusted to reduce the risk of harm to residents. Servicing of equipment such as hoists and the lift was now being carried out on a regular basis so that poorly maintained equipment was no longer a potential risk to residents. What the care home could do better: The overall rating of "adequate" for Anchor Lodge does not reflect on the person centred care that we observed and the good management in the home. The rating is due to our concern about the provider`s attitude to health and safety. The provider had put residents in the home at risk by not ensuring that there were systems in place for regular servicing and maintenance of equipment used by residents. They did not inform us that between 14th December 2006 and 14th April 2009 Anchor Lodge had been served with seven improvement notices and one prohibition notice by the Tendring Environmental Health Department due to breaches of health and safety legislation. They did not inform us, in line with Regulation 37, that a prohibition notice had been served on 8th April 2008 preventing residents using the lift for a week. In January 2009 Environmental Health informed us that for the third time in just over two years they had found no thorough examination of lifting equipment had taken place. They served a further two improvement notices on 16th March 2009 as the lifting engineer`s report highlighted the fact that there were two items that required immediate attention. Yet again the provider did not inform us about this. Safeguarding meetings were held in March 2009 as a result of the health and safety concerns in the home. As well as the concerns about lack of servicing of equipment used by residents, the provider had not addressed the unguarded radiators and concerns about water temperatures in some parts of the home despite this having been highlighted in a number of previous inspection reports. Some improvements in medicines management were needed. Residents told us that they would like the opportunity to go out on trips and outings but that there were usually insufficient staff for this to occur. Some risks in the environment were highlighted during the inspection. The manager was immediately taking steps to address these. Some improvements were needed in recruitment procedures in order to safeguard vulnerable residents. In June 2009 we requested information from the provider about the financial position of the home in line with Regulation 25. However, despite reminders the up to date information we required had still not been submitted to us at the time of writing this report. Key inspection report Care homes for older people Name: Address: Anchor Lodge Cliff Parade Walton-on-Naze Essex CO14 8HB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Francesca Halliday     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Anchor Lodge Cliff Parade Walton-on-Naze Essex CO14 8HB 01255850710 01255850710 chez40uk@yahoo.co.uk www.anchor-lodge.co.uk Mrs Uzaira Farooq,Mr Farooq Mohammed care home 14 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One person, under the age of 65 years, who requires care by reason of Korsakoff Syndrome (dementia) whose name was provided to the Commission in March 2004 Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 14 persons) Three persons, aged 65 years and over, who require care by reason of dementia, whose names were provided to the Commission in April 2005 Date of last inspection Brief description of the care home Anchor Lodge is an established care home situated in a residential area of Walton on Naze. Local shops, post office, library, churches and leisure facilities are all found in the town. The detached property overlooks the seafront with views of the beach and the sea from the home. There is a front garden in which people can sit. There is off road parking to the rear and side of the home. Accommodation is in twelve single Care Homes for Older People Page 4 of 34 Over 65 3 14 0 0 Brief description of the care home rooms and one double room, over three floors. Access to the upper floors is by means of a passenger lift and stairs. In recent years alterations and additions have been made to the bedroom accommodation, all now having en suite facilities of wash hand basin and toilet. Communal areas are a ground floor main lounge and dining room. There is also a small first floor lounge with sea views. The home charges between £374 - £650 a week for the services they provide. Additional charges are made for hairdressing, chiropody and toiletries. This information was given to us in December 2009. More up to date information about the home and fees can be obtained by contacting the manager. Inspection reports are available from the home and from the CQC website www.cqc.org.uk Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out on 1st December 2009. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 2nd February 2008, as well as evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. An expert by experience accompanied us for part of the inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experiences views and comments have been included in the appropriate sections of the report. During the inspection we had chats of various lengths with five residents, five relatives and three members of staff including the manager. We sent out surveys prior to the inspection and we received eleven from residents, some of Care Homes for Older People Page 6 of 34 which had been written with the assistance of staff. Comments from the surveys and conversations have been included in the report where appropriate. The report was written using evidence provided by the manager and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment required by law and provides an opportunity for the management to tell us what they think they do well and areas they are looking to improve and/or develop. It is anticipated that some improvements would be noted, as this contributes to the inspection process and indicates the homes understanding of current requirements, changes in legislation and their own audited compliance. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The overall rating of adequate for Anchor Lodge does not reflect on the person centred care that we observed and the good management in the home. The rating is due to our concern about the providers attitude to health and safety. The provider had put residents in the home at risk by not ensuring that there were systems in place for regular servicing and maintenance of equipment used by residents. They did not inform us that between 14th December 2006 and 14th April 2009 Anchor Lodge had been served with seven improvement notices and one prohibition notice by the Tendring Environmental Health Department due to breaches of health and safety legislation. They did not inform us, in line with Regulation 37, that a prohibition notice had been served on 8th April 2008 preventing residents using the lift for a week. In January 2009 Environmental Health informed us that for the third time in just over two years they had found no thorough examination of lifting equipment had taken place. They served a further two improvement notices on 16th March 2009 as the lifting engineers report highlighted the fact that there were two items that required immediate attention. Yet again the provider did not inform us about this. Safeguarding meetings were held in March 2009 as a result of the health and safety concerns in the home. As well as the concerns about lack of servicing of equipment used by residents, the Care Homes for Older People Page 8 of 34 provider had not addressed the unguarded radiators and concerns about water temperatures in some parts of the home despite this having been highlighted in a number of previous inspection reports. Some improvements in medicines management were needed. Residents told us that they would like the opportunity to go out on trips and outings but that there were usually insufficient staff for this to occur. Some risks in the environment were highlighted during the inspection. The manager was immediately taking steps to address these. Some improvements were needed in recruitment procedures in order to safeguard vulnerable residents. In June 2009 we requested information from the provider about the financial position of the home in line with Regulation 25. However, despite reminders the up to date information we required had still not been submitted to us at the time of writing this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that they will have their needs assessed prior to admission and will receive good support on admission. Evidence: The home had a statement of purpose and a guide for prospective residents. The statement of purpose was very brief and only provided minimal information about the home. The document incorrectly stated that the home was registered to admit residents with dementia (although some residents had developed a degree of dementia since admission). It also needed to be updated with the details of the current manager and the contact details of social services and CQC. The information guide for residents was out of date as it referred to the previous manager and to the previous regulator and was out of date in relation to the training and induction provided. The guide would have benefited from providing more information for prospective residents about what it was like to live in the home and more detail about the care and services provided. The manager confirmed that they had revised and Care Homes for Older People Page 11 of 34 Evidence: updated both documents following the inspection. Residents said that they or their family had received information about the home to help them decide whether it would be the right place for them. A relative told us that the manager had been very helpful and gave them plenty of information when they initially visited. Prospective residents were encouraged to spend time in the home, whenever possible, before making a decision about admission. A resident told us that they had visited Anchor Lodge before deciding that the home would suit them. A trial period of up to four weeks was offered in order to ensure that the resident and their family were happy with the care and services and wanted to accept a permanent place at the home. The home offered respite care for older people if there was a room available. The manager carried out the majority of pre-admission assessments. The assessment form did not have space for much detail and did not cover all potential needs. The assessments we looked at contained a basic assessment but there was a potential risk that residents could be admitted inappropriately or that equipment needed would not be available for use on admission if assessments were not sufficiently detailed. However, there was no evidence of any inappropriate admissions to the home at the time of inspection. The manager said that they would revise and expand the form following the inspection. Emergency admissions were rarely made and the manager said that they would always try to carry out a brief assessment beforehand when possible and carry out a more detailed assessment on admission. Relatives told us that staff were extremely supportive when residents were first admitted and helped them with the sometimes difficult transition to residential care. A relative said that staff had helped one resident through their grieving and anger when they were first admitted so that they were now very settled and happy in the home. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care that meets their individual needs. Some improvements in medicines management are needed to improve safety for residents. Evidence: Residents and relatives we spoke with told us that they were happy with the standards of care provided in the home. A resident told us We dont want for anything. If Im not well I stay in my room and they look after you well. A number of relatives were extremely complimentary about the fact that the condition of the residents they visited had improved considerably since they were first admitted. One relative said that the resident they visited was unrecognisable from the person they were when they first moved in. Another relative said they are so much better since theyve been here, their health has really improved and yet another described the incredible improvement in their health since theyve been here. Residents told us that they always or usually received the care and support they needed. Relatives told us how much they appreciated the fact that staff involved them in the residents care. Staff we observed had a friendly and caring manner and were respectful and Care Homes for Older People Page 13 of 34 Evidence: supportive towards residents. The expert by experience told us A resident over lunch was experiencing problems with their hearing aid, and when they asked for assistance, a carer kindly and efficiently fixed it for them. The residents response was Thank you, my dear, you are always so kind to me. I was impressed with the carers knowledge of the hearing aid, as I have noticed in some homes I have visited that carers are not able to deal with them very well. Residents told us that staff respected their privacy and treated their room as their private space. The expert by experience said I was able to note that the residents all looked well cared-for with clean and weather-appropriate clothing, together with neat and tidy hair, and clean nails. Indeed, one resident was very proud of their manicured and polished nails, when I commented on them. This was indicative of the care given at Anchor Lodge during my time there. We looked at the care records for three residents. The care plans were of a good standard and focused on the individual needs of each resident. They contained details of residents preferences, care needs, abilities and the assistance they needed with different aspects of their care. One care plan clearly demonstrated how a resident was supported to remain as independent as possible and how staff should respond to their individual needs. The care plans had been evaluated each month and demonstrated that staff were monitoring residents wellbeing on a continual basis. One relative considered that the home should offer residents more drinks, they said Hydration is so important, I dont feel that its given a high priority. Residents should be given more regular drinks. The manager said that they would ensure that staff were reminded of the importance of offering residents regular drinks. The home had a range of risk assessments to assess residents condition and prompt staff to take preventative measures when necessary to prevent harm. These included assessing the risk of falls, the risk of malnutrition, the risk of developing pressure sores, mental health risk assessments and the risks of moving and handling residents. Residents weight was monitored monthly unless there were any concerns about their condition or they had unplanned weight loss, in which case they were weighed more frequently. Accident records were well completed. Relatives whom we spoke with told us that staff always kept them up to date with residents condition and always let them know about any accidents or health concerns. One relative told us that as well as keeping them up to date about concerns I really appreciate that they ring me up with good news as well. Residents had visits from a chiropodist on a six weekly basis, optical tests were carried out in the home twice a year and a community dentist visited the home three monthly. Residents told us that staff made sure that they received the medical care they Care Homes for Older People Page 14 of 34 Evidence: needed. One resident said They call the doctor when necessary. The manager said that they used the services of the Walton practice unless residents from Frinton wished to retain their GP. The manager told us that they generally had very good medical support but that a small minority of GPs were less supportive of elderly residents needs. The manager said that the home had brilliant support from local district nurses nothing is too much trouble for them. They also had excellent support from the mental health nurses who provided advice and carried out mental health assessments when necessary. The manager said that they had excellent support from the Macmillan nurses if a resident was terminally ill or dying and confirmed that they developed an end of life plan in consultation with the resident, relatives and health professionals. The home had changed their supplying pharmacy since the last inspection and staff felt that the new system was much improved. The medicines trolley was being stored in a bathroom that was regularly used. This was not an ideal place for the storage of medicines due to fluctuating temperatures and high humidity. The temperature in the room was not being monitored so that staff could assure themselves that medicines were being stored constantly below 25c. This could mean that residents were being given medicines when they were no longer fit for use. The manager said that she had ordered a maximum/minimum thermometer so that the range of temperatures could be monitored accurately and would consider whether there was an alternative and more appropriate storage place for the trolley. Medicines that were left over from the previous month and were not in an MDS system did not have the amount left over brought forward. It was therefore not possible to accurately assess what dose of these medicines residents had taken. Medicines with a limited shelf life were not being dated on first opening. This could potentially mean that residents were given medicines when they were no longer fit to be used. Some painkillers that were prescribed to be given as required up to four times a day were only being offered to residents twice a day. It was not always possible to establish what dose residents had been given when they were prescribed a variable dose. One antibiotic eye ointment prescribed to be given four times a day was only being given three times a day. The manager said that they would get the pharmacist to label the medicine itself and not just the outer carton and ask the GP to give clear instructions on the prescription for medicines prescribed as required. The medicine administration records were generally well recorded with only two gaps noted in the sample we looked at. The manager confirmed that staff who administered medicines had received training and an assessment of competence before administering medicines on their own. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had access to activities but limited opportunity for trips out of the home. Evidence: The majority of residents considered that there were usually or sometimes activities that they could take part it. One resident said that they would like to be able to go out more but felt that there were not always enough staff to do this. A relative considered that the home was short staffed and needed to have more individual and group activities. They said that there was a list of activities outside the lounge but they did not think that a number of activities on the list were held. The manager said that the home used to have an activities coordinator but they had not been replaced when they left. She said that she would identify a member of staff to develop and lead activities but said that it was not possible to take residents out when there were only two staff on duty. One relative told us how much happier the resident they visited was now they were in the home. They told us how how staff made them laugh and had then joining in the dancing which theyd never done before. The activity records were very brief and needed to give a better indication of how residents had responded to activities. The manager said that residents enjoyed singalongs and liked to have pedicures and Care Homes for Older People Page 16 of 34 Evidence: manicures. The home had ordered some additional games with money they raised. Staff brought pets into the home, which the residents particularly enjoyed. Armchair exercises were held once a week in order to improve residents muscle strength, coordination and mobility. The manager said that they held a bring and buy sale outside the home and that residents thoroughly enjoyed helping at the stall. Staff encouraged residents to maintain their independence and their interests. One resident who loved sewing carried out some repairs and a resident who used to be very house proud was involved in dusting. The manager said that these residents gained immense satisfaction from carrying out activities that were valued in the home. The expert by experience said Most of the residents went back into the lounge after eating lunch, and I was genuinely surprised that none of them fell asleep, as in many homes. There was so much lively banter between staff and residents, and an almost constant stream of visitors to the home, that they all looked very alert, and interested by what was going on around them. It was nice to note that none of them was left out, and the staff tried very hard to involve the quieter ones. The manager said that they tried to arrange for an entertainer to visit the home at least twice a year. Six residents attended the local day centre once a week and a number of residents also attended a local church on Sunday. They were collected and brought back in the day centre minibus. The expert by experience said It seemed that lots of the residents really enjoy this outing every week, and look forward to seeing the other members of the church. This appeared to be a very important link with the local community, and I felt very pleased that the residents had this opportunity to attend church, if they so wished. Local schools visited the home and the Salvation Army also visited. The manager said that children from three schools were due to visit around Christmas. The mobile library visited once a month and brought books that residents had requested. The manager said that they encouraged relatives to have Christmas dinner with the residents. Relatives told us that they were made to feel very welcome and always offered a cup of tea when they visited. One relative said Ive visited all times of the day and night and every time its been fine. Residents told us that they always or usually liked the meals in the home. The manager told us that residents were involved in deciding the meals on the menu. There were choices at every meal, residents were asked what they wanted to eat before every meal. Staff said that the food was all home made. The manager told us that snacks were available at all times if residents felt hungry outside mealtimes. One relative told us that the resident they visited loves the food. The dining room was small and at the last inspection could not accommodate all residents if they wished to eat at the same time. The dining room furniture had been changed to smaller tables Care Homes for Older People Page 17 of 34 Evidence: and the room could now accommodate sixteen people. The expert by experience told us The dining room was very small, and I noticed it was quite hard for the two carers to move around with the lunches, as they had to squeeze between chairs and tables. It was particularly awkward moving residents who were in wheelchairs, and manoeuvring them into their places at the tables. The amount of room also did not make it easy for staff to help residents who needed assistance to eat an adequate meal. The manager told us that in order to solve this problem in the New Year they were planning to have two sittings at mealtimes. They said that at times like Christmas when relatives joined residents for a meal they set up the much larger lounge with the dining room tables and chairs. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents concerns are promptly addressed but the safeguarding of residents is not always prioritised. Evidence: Residents told us that they knew who to speak to if they had any concerns or complaints. The complaints procedure had a positive statement about receiving complaints, which stated. We view complaints as an opportunity to identify anything that is going wrong in the home and to make it right. You can help us by looking out for any problems and letting us know about them as soon as possible. Your comments and suggestions for improvements are always welcome. The manager said that they would update the procedure to reflect the current manager, social services role in investigating complaints and update the contact details of CQC. The manager said that the home had received no complaints but staff were not recording the more minor verbal concerns as part of good quality assurance. The manager said that this would be done following the inspection. Residents told us that staff always or usually listened and acted on what they said. Relatives told us that they had not had any complaints and said that staff addressed any concerns very promptly. There had been two safeguarding referrals since the last inspection. One, in June 2008, related to a resident going without their medication for five days. This was investigated, reported and appropriate action was taken by the previous manager to resolve the issues raised. The second safeguarding referral in February 2009, related Care Homes for Older People Page 19 of 34 Evidence: to concerns raised by Environmental Health about the providers repeated failings to ensure that equipment used by residents was safe and fit to be used and ensuring that radiators and hot water did not pose a risk to residents (see the management section of the report). The current manager told us that they were now systems in place to ensure that all servicing and maintenance was carried out on time. A member of staff we spoke with had an understanding about safeguarding issues and how to report any concern about abuse or poor practices. Relatives told us that they considered that residents were kept safe in the home. One relative said theyre safe and secure here. Another said we feel theyre safe and well looked after. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and homely home but some risks in the environment remain. Evidence: A Christmas tree and some decorations had been put up in the lounge and a few in the hall, which made it look quite festive, and a number of the residents said how much they liked looking at them all. The home was situated on the sea front and the front garden had plenty of seating and parasols that could be used in sunny weather. The bedrooms were of a variety of shapes and sizes as the home had been converted from a domestic residence. Many of the residents rooms had sea views. The home had twelve single rooms and one double room. The double room was being used for single occupancy at the time of this inspection. Residents had personalised their rooms with their belongings and mementoes and they looked very homely. The home had a communal lounge and a small dining room on the ground floor and a small lounge on the first floor. The first floor room had a lovely sea view, however, this was marred by the heavy condensation between the double glazing panes, probably caused by damaged window seals. There was peeling wallpaper in some rooms and the manager said that further redecoration of the lounge and some bedrooms was planned. The ramp outside the French windows, which led from the lounge into the garden was very steep and there was no handrail for residents to use, making this exit into the garden unsafe for residents to use. During the inspection we noticed a resident opening the French windows. A recommendation to address this potential risk Care Homes for Older People Page 21 of 34 Evidence: to residents was made in the last inspection report and it was expected that a home rated at the time as good would address this potential risk to residents without our having to make a requirement in a subsequent report. The manager said that a keypad was being fitted to the front door as one resident, who was confused , had left the home recently. The manager confirmed that the keypad had been fitted following the inspection. Residents did not have a lockable drawer in their room for them to hold valuables, money and medicines. The manager said that they held residents money in a safe. They said that there was no one managing their own medicines at the time of inspection. They said that they held residents medicines even when they were in the home for a period of respite. This would not encourage them to maintain responsibility for their medicines and retain their confidence and independence for when they went home again. The kitchen was not locked when staff were not present therefore residents, some of whom had a degree of dementia or confusion, had access to the hazards in the kitchen as well as access to the stone steps leading down from the kitchen to a storage area and the laundry. The manager confirmed that a lock had been fitted so that the kitchen door could be secured when staff were not present. There was an assisted bath on the ground floor that was used by the majority of residents. The shower on the first floor was used occasionally by one resident. The home another bath on the second floor that did not have a hoist. The manager said that this bath was not currently in use and was mainly used as a store room. The manager confirmed that radiators had been covered since the last inspection so that the hot surfaces no longer posed a risk to residents and that window restrictors were in place on all windows above the ground floor. The home was clean and there were no unpleasant odours on the day of this inspection. The manager said that they had an excellent carpet shampooer. The majority of residents considered that the home was always kept fresh and clean and relatives we spoke with confirmed this. Residents told us that they were happy with the laundry service. The laundry had been refurbished since the last inspection and the newly tiled floor and walls could now be kept in a hygienic condition. The washing machine had a hot wash to enable staff to wash soiled linen appropriately and staff told us that they used the red bags for handling soiled linen. The home did not have a supply of liquid soap and paper hand towels in all residents bedrooms and areas where personal care was carried out. This would not enable staff to carry out appropriate infection control procedures and could increase the risk of cross infection within the home. The manager confirmed that the liquid soap and paper hand towels Care Homes for Older People Page 22 of 34 Evidence: had been put in each area and that they were going to order holders for the soap and towels. The home had a supply of clinical waste bags and systems in place for disposing of clinical waste. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care from adequate number of staff but the homes recruitment processes do not fully protect them. Evidence: The expert by experience said I chatted to some of the staff after lunch, and they all told me that they enjoyed working at Anchor Lodge, as they felt valued and they enjoyed the friendly atmosphere of the home. They were all very friendly, clearly had good people skills and were able to engage easily in conversation with those in their care. They were also very supportive of the manager of the home, saying that she worked hard, and cared deeply for those in her charge. One of the carers told me that they much preferred working at Anchor Lodge to the local care home they had previously worked in, as it had been far more impersonal and uncaring. The staffing levels were two care staff during the day, one awake during the night and one asleep and on call if needed. The manager was supernumerary to these numbers on three days a week to allow them to carry out administrative tasks. In addition there was a cook from 08:00 to 13:00 every day. The care staff carried out the cleaning and laundry and provided the evening meal. Residents told us that staff were always or usually available when they needed them. There were twelve residents at the time of inspection and their dependency was generally fairly low. The manager confirmed that none of the residents needed two staff to assist them with care. The Care Homes for Older People Page 24 of 34 Evidence: manager said that staff covered holidays, sickness and absence and that the home did not use any agency staff. The staffing levels were adequate for the numbers and dependency of residents at the time of inspection but would need to be increased if dependency levels changed. One relative said that the heavy accents of a few foreign staff made it sometimes difficult for residents to communicate with them. They said that this was particularly difficult if residents were deaf or had some degree of confusion. All care staff had completed the national vocational qualification at level 2 apart from one member of staff who was currently on the course. Staff received an induction in line with skills for care. We sampled three staff records and they showed that the home needed some improvements to the recruitment procedure. Applicants had a criminal records bureau check carried out and references obtained before they were offered a post at the home. The application form did not include a space for applicants to make a declaration about previous convictions or a health declaration. None of the files we looked at had a declaration about previous convictions and only one had a health declaration. The manager said that they would ensure that a health declaration was obtained for all staff if not already on file. Applicants completed a questionnaire about the role they were applying for prior to the interview. The manager did not complete a record of the interview in line with good equal opportunity practices but said that they would do so in future. The manager had a training programme and was ensuring that staff had regular training to enable them to carry out their role. Additional training in dementia care was needed as the home was caring for some residents with short term memory problems and early dementia. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care is well managed but health and safety is not always prioritised. Evidence: The manager had been in post for about a year but had not applied to be registered with the commission. They said that they would make an immediate application following the inspection. They were currently working towards the registered managers award. Relatives told us that they were very happy with the management of the home. One relative said the home runs very smoothly. Staff told us that the manager was very caring and supportive. The expert by experience described the manager as a caring and hard-working lady, who clearly does all she can to give her residents a good quality of life, and values them all as individuals. The manager said that they had not carried out any surveys within the home or with relatives and visiting professionals but said that they would do so regularly in future. The manager had an open door policy and it was evident during the inspection that they were running the home in the best interests of residents. There was a friendly Care Homes for Older People Page 26 of 34 Evidence: and happy atmosphere and we heard residents laughing with staff on numerous occasions during the day. The manager had held two formal staff meetings in the past year. The minutes showed evidence that the manager was using the meetings to discuss and improve standards within the home. The proprietor carried out Regulation 26 visits in order to monitor standards in the home. The manager had a number of audits, which they carried out. These included health and safety, management, activities and care plans. The manager said that they would add a medicine audit. The manager confirmed that staff had supervision six times a year and we saw evidence of regular documented supervision. One of the records we looked at included very good observations of one member of staffs care practices. The provider did not inform us that between 14th December 2006 and 14th April 2009 Anchor Lodge had been served with seven improvement notices and one prohibition notice by the Tendring Environmental Health Department due to breaches of health and safety legislation. On 8th April 2008 a prohibition notice was served on the lift preventing its use, due to the fact that servicing had not been carried out and was overdue by five months. We were not informed that the lift was out of action for a week or about the steps being taken to minimise the impact on residents. On 13th January 2009 Environmental Health informed us that for the third time in just over two years there was no evidence of routine inspections being carried out on any of the lifting equipment in the home as the certificates produced had expired by several months. They served a further two improvement notices on 16th March 2009 as the lifting engineers report highlighted the fact that there were two items that required immediate attention. Yet again the provider did not inform us about this. The safeguarding meetings held in March 2009 related to the health and safety contraventions highlighted by Environmental Health and also to the fact that the provider had not addressed the unguarded radiators and concerns about water temperatures in some parts of the home, despite this having been highlighted in a number of previous inspection reports. The steep exit out of the lounge into the garden had not been addressed despite this having been highlighted in the last inspection report. In June 2009 we requested financial information from the provider about the financial position of the home in line with Regulation 25. However, despite reminders the up to date information we required had still not been submitted to us at the time of writing this report over six months later. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must monitor the temperature in all medicine storage areas and take action if the temperature is above the safe limit of 25c. Medicines must be given or offered to residents as prescribed. Staff must date medicines with a limited shelf life on first opening. The amount of medicines left over from the previous month must be recorded so that audits can be carried out and staff must record the actual dose given when a variable dose is prescribed. In order that residents receive medicines that have been safely stored, accurately recorded and are given to them as prescribed. 01/02/2010 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 12 16 A member of staff must be appointed to lead and organise activities and take residents on outings and trips out of the home. In order to improve residents quality of life. 22/02/2010 3 18 13 The provider must ensure that health and safety is given a high priority, is appropriately funded and that concerns relating to health and safety are promptly addressed. In order to safeguard residents from preventable risks. 25/01/2010 4 19 13 The exit from the lounge into the garden and the steep ramp must be made suitable for current residents use. In order that residents can use the exit safely and independently. 01/03/2010 5 19 13 Staff must ensure that the kitchen is kept locked at all times when they are not present. In order to safeguard residents from risks within the kitchen and from access 25/01/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to the store room, laundry and stone steps. 6 24 12 Residents must be provided with a lockable drawer in their room. In order to encourage residents to maintain their independence by giving them the opportunity to retain control of their medicines, money and valuables if they wish. 7 26 13 Staff must be supplied with 01/02/2010 the appropriate equipment to enable them to carry out good infection control procedures. (This refers to the supply of liquid soap and paper hand towels in all areas that staff carry out personal care). In order to reduce the risk of cross infection to residents and to themselves. 8 29 19 The manager must ensure that recruitment procedures meet requirements (this refers to obtaining a declaration about previous convictions and ensuring that potential staff are physically and mentally fit for the job that they are applying for). 01/02/2010 15/02/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action In order to protect vulnerable residents. 9 30 18 Staff must receive more in depth dementia care training. In order to enable them to meet residents needs. 10 34 25 The provider must provide us with all the financial information requested in June 2009. In order that we can establish that there are sufficient funds to safeguard residents and meet their individual needs. 11 38 37 The provider and manager must notify CQC about any event in the home that adversely affects the wellbeing and safety of residents. In order to confirm that residents safety and wellbeing have been given a high priority within the home. 01/02/2010 01/03/2010 03/05/2010 Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The pre-admission assessment should be expanded to cover potential residents needs. In order to accurately assess whether the home can meet their needs and whether any equipment needs to be in place on admission. Staff should record minor verbal concerns as part of good quality assurance. In order to ensure that small and potentially repeated concerns do not develop into more serious complaints. 2 16 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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