Care Home: Anjulita Court

What the care home does well Both inspectors commented on the completely different atmosphere in the home to that we had experienced at previous visits. It was as if the home is beginning to `come alive`. The staff seemed much happier in their jobs, and this seemed to be `rubbing off` on the people who live at Anjulita Court. We saw that people who live here and the staff team have friendly, caring, yet professional relationships and seem to enjoy each others company. People we spoke with were generally pleased with the service they receive at the home. One said "For anyone who`s got to be in a home, it`s a very good place to be". Another said "I think it`s splendid. I have a lot of freedom and I`m perfectly happy". Staff we spoke with said "I love it here"; "It`s so rewarding - such a lovely job"; "I`m very pleased to be working here"; and "It`s lovely here". There is a detailed Service User Guide and information pack which give people good information about what they can expect from the home. Full assessments of people`s needs are carried out before they are offered a place at Anjulita Court, and people are invited to visit as often as they like, if possible, to make sure they want to live here. A number of volunteers have been recruited, to assist with activities. The coffee shop in the entrance hall is open for people to get teas/coffees and snacks, and a small shop is open once a week. 2 activity coordinators have been appointed who are very enthusiastic and the range and number of activities on offer to people has improved markedly. There are now organised activities every day including entertainment coming into the home, trips out, and in-house activities for groups of people, and on a one-to-one basis. A new catering manager has been appointed, and generally meals have improved. There is more choice for people now on the menus and plenty of alternative meals available. Tables are set nicely for meals and people were enjoying a pleasant social occasion when we walked round at lunchtime. The environment is excellent, with lots of space for people both indoors and outdoors, and a selection of rooms for people to use. The whole home is furnished to a high standard, and residents are encouraged to personalise their bedrooms if they want to. There are additional facilities, such as the hydrotherapy pool, quiet room for worship, lounge where films can be screened, and the coffee shop. The housekeeping team keeps the home very clean, so there are no unpleasant odours. There are now a good number of permanent staff, so the amount of agency staff being used has decreased dramatically. Staff, and people we spoke with said this has made a big difference to people who live here. We observed there were sufficient staff on duty and people`s needs were being met, although staff in one unit told us they struggle in the mornings. Staff are recruited well and receive a thorough induction. Both new managers are suitably qualified to manage a care home, and complement each other`s strengths. The quality assurance system is gradually taking shape, with a number of audits being carried out regularly, and reports of visits (as required by regulation 26) by a representative of the organisation, being done regularly. Residents` money is kept safe. What has improved since the last inspection? Almost all areas of the service offered at Anjulita Court have improved in the 6 months since our last inspection. In particular the way medication is dealt with has improved enormously, and the activities available to people who live here have made life so much more enjoyable for people. All the requirements made about medication following the inspections in December 2009, January 2010 and April 2010 have now been met, and 5 of the other 7 requirements made in December have also been met. What the care home could do better: Although there has been considerable improvement in the service, there are still a number of things the home must do better. The new managers and the area manager are very aware of this, which is re-assuring. 2 of the requirements from the previous inspection have not been fully met, so they have been repeated, and we have made a further 4 requirements. We have also made 1 recommendation. Some of the things the home must do better include: - develop care plans that give staff full details about each person`s needs, including the way in which that person wants those needs to be met, and ensure that staff follow the guidelines; - make sure that robust auditing of medication continues to take place; - ensure that any agency nurses employed have been trained and are competent to administer medication; - arrange training for staff in safeguarding vulnerable adults; - have a person trained in first aid on duty at all times; and - make sure all staff receive training in the 5 `mandatory` health and safety topics (fire safety, first aid, infection control, food hygiene, moving and handling), and in any other topics they need (for example, care of people with dementia), so that they can do their jobs as well as possible . We recommend that all staff should receive regular supervision. Currently there is no registered manager. The organisation must address this as soon as possible. Key inspection report Care homes for older people Name: Address: Anjulita Court Anjulita Court Bramley Way North Brickhill Bedford Bedfordshire MK41 7GD     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: Nicky Hone     Date: 0 4 0 6 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Anjulita Court Anjulita Court Bramley Way North Brickhill Bedford Bedfordshire MK41 7GD Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) www.mha.org.uk Methodist Homes for the Aged Type of registration: Number of places registered: care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 62 The registered person may provide the following categories of service: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE Date of last inspection Brief description of the care home Anjulita Court is a stunning new building which has been designed to give a feeling of space throughout, and has been built round a large enclosed courtyard. On their website, the MHA describes it as: The impressive new building has a dramatic triple arch frontage to welcome residents and visitors into an interior full of open spaces, as Care Homes for Older People Page 4 of 34 Over 65 0 62 62 0 1 5 1 2 2 0 0 9 Brief description of the care home well as facilities that include a hydrotherapy room, hairdressing salon, and a range of lounges - one of which is set up to allow film screenings. The spectacular entrance hall has a very high ceiling, and two walls are almost completely glass. The accommodation is divided into 4 units, each of which is selfcontained with a lounge, quiet room, sitting areas, dining room, kitchenette, bedrooms, and bathrooms. All bedrooms (a few of which are double rooms) have an ensuite shower room. There are 2 units each side of the hall, 2 on the ground floor and 2 on the first floor. The first floor units are accessed by stairs and lifts, and there is a walkway at first floor level across the hall so that people can walk from one unit to the other. There is a main kitchen on the ground floor, and a very large laundry, as well as offices, and staff facilities. There is a coffee shop in the entrance hall which is open to the general public and staffed by volunteers. It is hoped this be used more once the flats next door have been completed, and the surrounding area has been developed into a country park. There are fenced gardens all round the building, with a series of pathways and seating areas, and a large landscaped courtyard opening off the entrance hall. There is adequate parking to the front of the building. Anjulita Court is registered to offer accomodation to older people and older people with dementia, the majority of whom will be over 65 years of age. However, if the home can meet their needs, people under 65 years of age with dementia can also be accommodated. 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 is the second key inspection of Anjulita Court following its registration with CQC in August 2009. On the day we visited the home there were 30 people living here. The residential unit (Milton), nursing unit (The Grange) and residential dementia unit (Redlands) were open with a number of people in each unit. The 4th unit has yet to open. For this inspection we (the Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection of Anjulita Court in December 2009. This included information from the random inspections we have carried out and other information detailed below. We did not ask for an Annual Quality Assurance Assessment (AQAA) from the manager for this inspection, and we did not send surveys to anyone to ask their opinion of the home. We asked the manager for some information which she sent to us after the site visit. Care Homes for Older People Page 6 of 34 This inspection of Anjulita Court included a visit to the home on 02/06/2010 by a compliance inspector and a pharmacist inspector. No-one who lives or works at the home knew we were going to visit on this day. The pharmacist inspector carried out an audit of the homes medicine management, and the compliance inspector carried out a key inspection, including checking that the home had complied with the requirements made on 15/12/2009. We spent time talking with people who live at the home, the general manager, home support manager, area manager and with some of the other staff. We looked at some of the paperwork the home has to keep including care plans, staff personnel files, staff rotas, activities and menus. Some of the views and comments from people we spoke with are included in this report. Following the inspection on 15/12/09 we made 14 requirements, 7 of which were about medication. We gave the home a 0 star poor quality rating. Immediately following the inspection we sent a serious concerns letter to the provider, detailing our concerns about medication, and giving the service tight timescales in which to put things right. 2 inspectors, including a pharmacist inspector, carried out a random inspection on 29/01/2010. We concentrated on looking at medication. The pharmacist inspector concluded that there had been no improvement in medicine management: none of the 7 requirements had been met, and the pharmacist inspector made a further 6 requirements about other aspects of medication management. A discussion with the manager suggested that little progress had been made to meet the other requirements. At this stage we considered taking enforcement action. We held a Management Review on 08/02/2010, following which we issued the provider with a warning notice and asked for an improvement plan. We held a meeting with the Responsible Individual(RI) and the manager on 15/02/2010, at which we stressed how serious the situation was, and how concerned we were that no progress had been made since the December 2009 inspection. The RI explained that the area manager who should have been overseeing the management of the service had gone off sick. An interim area manager had been overseeing the home and the new area manager commenced her position fully in early January, following her induction, and was present at the meeting. Whilst this change in management was no excuse, it resulted in the organisation missing vital signs that no improvement was being made. An improvement plan had been produced, some of the work was underway, and the RI agreed to get the full, updated improvement plan to CQC by the required date of 08/03/2010. The organisation also agreed, with immediate effect, to voluntarily stop admitting new residents (other than 1 person who had already sold their house so would be homeless). Meanwhile, between the inspection on 15/12/2009 and the meeting with the RI on 15/02/2010, 2 safeguarding alerts had been raised with the local authority by the relatives of 2 people who had been living at Anjulita Court. Both families had moved their relatives from the home: one had gone to a local home run by a completely different provider, the other had agreed to go to another MHA home where he (and his family) have since been very impressed with the care. We attended a strategy meeting held by the local authority where representatives of the provider were present. The manager was suspended and subsequently left the organisation, and an interim manager from another MHA service took over the management. 2 inspectors, including the pharmacy inspector, carried out a random inspection on 08/04/2010. We noted that there had been a marked improvement in the management Care Homes for Older People Page 7 of 34 of medication, and the pharmacist judged that all the requirements relating to medication had been met. In May 2010 a new general manager, Anna Marrah, and a home support manager, Eileen Brown, started work at Anjulita Court. Care Homes for Older People Page 8 of 34 What the care home does well: Both inspectors commented on the completely different atmosphere in the home to that we had experienced at previous visits. It was as if the home is beginning to come alive. The staff seemed much happier in their jobs, and this seemed to be rubbing off on the people who live at Anjulita Court. We saw that people who live here and the staff team have friendly, caring, yet professional relationships and seem to enjoy each others company. People we spoke with were generally pleased with the service they receive at the home. One said For anyone whos got to be in a home, its a very good place to be. Another said I think its splendid. I have a lot of freedom and Im perfectly happy. Staff we spoke with said I love it here; Its so rewarding - such a lovely job; Im very pleased to be working here; and Its lovely here. There is a detailed Service User Guide and information pack which give people good information about what they can expect from the home. Full assessments of peoples needs are carried out before they are offered a place at Anjulita Court, and people are invited to visit as often as they like, if possible, to make sure they want to live here. A number of volunteers have been recruited, to assist with activities. The coffee shop in the entrance hall is open for people to get teas/coffees and snacks, and a small shop is open once a week. 2 activity coordinators have been appointed who are very enthusiastic and the range and number of activities on offer to people has improved markedly. There are now organised activities every day including entertainment coming into the home, trips out, and in-house activities for groups of people, and on a one-to-one basis. A new catering manager has been appointed, and generally meals have improved. There is more choice for people now on the menus and plenty of alternative meals available. Tables are set nicely for meals and people were enjoying a pleasant social occasion when we walked round at lunchtime. The environment is excellent, with lots of space for people both indoors and outdoors, and a selection of rooms for people to use. The whole home is furnished to a high standard, and residents are encouraged to personalise their bedrooms if they want to. There are additional facilities, such as the hydrotherapy pool, quiet room for worship, lounge where films can be screened, and the coffee shop. The housekeeping team keeps the home very clean, so there are no unpleasant odours. There are now a good number of permanent staff, so the amount of agency staff being used has decreased dramatically. Staff, and people we spoke with said this has made a big difference to people who live here. We observed there were sufficient staff on duty and peoples needs were being met, although staff in one unit told us they struggle in the mornings. Staff are recruited well and receive a thorough induction. Both new managers are suitably qualified to manage a care home, and complement each others strengths. The quality assurance system is gradually taking shape, with a number of audits being carried out regularly, and reports of visits (as required by regulation 26) by a representative of the organisation, being done regularly. Residents Care Homes for Older People Page 9 of 34 money is kept safe. What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 10 of 34 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 11 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 12 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. Good information about the home is available for people who are thinking about moving here, and people know their care will be based on a thorough assessment of their needs. Evidence: Methodist Homes for the Aged (MHA) produces a statement of purpose and service user guide which each home personalises. The personalised service user guide for Anjulita Court is full of useful information so that people who are thinking of moving here know what to expect. A pack of information about Anjulita Court has also been produced for people who are thinking about moving here. The manager told us that on the morning of this inspection, before we arrived, she had remembered that the statement of purpose and service user guide had not been updated with details about herself and the home support manager. The manager told us that a full assessment of each persons needs is carried out Care Homes for Older People Page 13 of 34 Evidence: before the person is offered a place at the home. One of the senior team visits the person where they are living (if possible), and people are invited to visit the home. If people live some distance away, a manager from another MHA home will carry out the assessment. At our previous inspection we saw that these full assessments are available on each persons file. Intermediate care is a service offered by some homes, which gives short-term, intensive rehabilitation for people leaving hospital before they return to their own homes. This service is not offered at Anjulita Court therefore standard 6 is not applicable. Care Homes for Older People Page 14 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. Care plans still do not give staff enough detail or guidance to make sure they can meet peoples care needs. People can be assured that there has been much improvement in the way medication is handled. Evidence: We looked at one persons care plan file and noted that there were fewer documents than had been in the files at our last inspection. This made information easier to find, but the plan was still difficult to follow, with information being recorded in several different places, and some information missing. The manager and home support manager told us that they had realised that some of the documents that MHA requires to be in each persons file, were not in every file, and some of the files were very muddled, with a lot of information which should be archived. The home support manager showed us that she was in the process of auditing each file, putting missing documents in place, and making sure everything was in the right order, and indexed. The person whose records we looked at was in bed on the day we visited as s/he had developed a small pressure sore. The care plan had been re-written 2 days previously Care Homes for Older People Page 15 of 34 Evidence: to reflect this, but there were no clear guidelines about management, including whether the person needed to stay in bed, and if so, for how long. On this file we noted that when s/he moved in this person had said they would like to lose weight, but had in fact gained almost 8.5kgs since they were admitted last autumn. There was nothing in the care plan about any discussions with the person about weight loss, no indication that a dietitian had been involved, and nothing to show there were any special menus or foods for this person. The pharmacist inspector looked at the healthcare sections of another 2 care plans. One was completed well. In the other plan we could find no evidence that staff had followed the guidelines regarding the persons blood sugar levels (see below). Both managers agreed that the care plans were not yet as they would want them to be, and not yet being used correctly by staff. A staff meeting had been arranged for the day after this inspection, to discuss the plans fully with the staff, and explain how they should be used, and where information should be recorded. One of the managers said Theres still a fair way to go on care plans, but a good starts been made. The pharmacist inspector carried out an inspection of all aspects of the medication. She wrote: We inspected the safe management of medication in the residential and the nursing units and followed up on requirements made at a random inspection in April 2010. We noticed that throughout the home there was good recording of receipts, administration and disposal of medication. We noticed no omissions on the MAR (Medication Administration Records) and that the disposal book was up to date. When a service user was in hospital or refused medication, this was recorded appropriately. When a variable dose of a medicine was prescribed the actual dose administered was always recorded, so the prescriber was able to review the medication. We counted a total of 23 samples of medication supplied in their original containers and apart from 2 all could be reconciled with records on the MAR. In the nursing unit we found that these two instances were where medication was left in the blister but signed on the MAR as given. We were told by managers and nurses that the home was still having to employ some agency staff who were not fully trained in the homes auditing procedures. However, overall we were satisfied that medication was being administered as prescribed. We observed medication being administered to two service users and saw that it was Care Homes for Older People Page 16 of 34 Evidence: given with respect and professionally, and in line with the homes policies and procedures, We noticed that the trolley was left open between each resident though, and that this made it difficult to push along the corridor. There was evidence of review of medication by the GP, hospital consultant and all visits by healthcare professionals were documented in the care plans. When a dose was changed or discontinued this was clearly stated on the MAR and signed and dated. We looked at controlled drugs and they were stored securely in a cupboard complying with the Misuse of Drugs Act and balances in the register were accurate and correlated with records on the MAR. We saw that two service users were fully self medicating. There were risk assessments in place which had been updated in May 2010 and evidence of stock checks to assess compliance. One service user showed us the locked cupboard where she kept her medicines and told us how she took them and also how she managed her diabetes. The home was using professional lancets for testing blood glucose in service users who were diabetic. We looked at the care plans of two service users, one of whom was diabetic. It was comprehensive with details of how to monitor and record blood glucose and manage the diet. We saw that the care plan stated that if the blood glucose exceeded 12.5 that a referral to the GP should be made. On 31/5 there was a record of the blood glucose reading 17.5 but we found no evidence of referral to the GP. For another service user there was a comprehensive care plan detailing visits to hospital, referrals to health care professionals such as dietitians and speech and language therapists, and the introduction of pressure relieving mattresses and fluid and food balance charts. Staff had received further medication training in May and reasonably robust auditing procedures were in place. Staff were checking balances of medicines not supplied in an MDS (Monitored Dosage System) on a daily basis and were checking MAR charts for recording errors at each handover. Managers were carrying out their own regular audits. Overall we were satisfied that the previous requirements made for medication had been met. The nursing unit still needs to raise it standards to the level achieved by the residential unit. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range and amount of activities offered to people, so that they can lead full, satisfying and interesting lives, have improved markedly. Evidence: A new activity coordinator, and assistant activity coordinator have been appointed and work 64 hours a week between them. They vary their hours depending on the activities they have arranged, and they try to involve other staff in activities. The activity coordinator told us that she is really pleased that some of the other staff are getting more on board, realising that she is the coordinator, not the only one who does activities. Over the Bank Holiday weekend just before this inspection, when neither she nor the assistant activity coordinator were available, staff carried on with the planned activities. During the morning we saw that several of the people who live at Anjulita Court were sitting in the courtyard, doing a number of things. Some of the ladies were wearing the Easter bonnets theyd made for Easter, to protect them from the sun. They were joined from time to time by other staff, the managers, the operations manager and so on, and there was a lot of lively conversation and activity going on. One persons daughter was visiting, and was helping him do some weeding in the garden. Although Care Homes for Older People Page 18 of 34 Evidence: she spent some time in the garden, the activity coordinator was also making sure that other people had things to do if they wanted them. For example, one person had to stay in bed for the day, so a portable DVD player had been lent to him so he could watch films about Bedford. He said he was very comfortable, lying in bed, with the DVD player on his overbed table, close enough for him to see and hear. Later on there was a church service in the Gordon Barrett room which was packed with residents and their relatives. One of the managers said the activity coordinator has been absolutely brilliant, she has brought the home to life. Her enthusiasm is infectious and the home is very fortunate to have found her. We spent some time talking to the activity coordinator who admitted she was so enthusiastic about her job she could spend all day telling us about things that were going on, and activities she is planning for the future. She said that some ideas theyd tried had not been successful, but they were trying new things all the time. They arrange for outside entertainment to come into the home, take people out, and organise a wide range of things for people to do. Each week an activity planner is produced and a copy given to each person, as well as copies put on notice boards around the home. A few examples included: parachute games were played the day before our inspection; Easter bonnets were made and a raffle held; a lady plays the organ regularly; sing-a-longs are very popular; garden furniture has been bought so people can sit outside; raised planters have been made by the maintenance staff so that vegetables can be grown; and reminiscence is done every few weeks. There are exercise sessions, painting classes, computer time, board games and crafts, as well as one-to-one activities such as hand massages and manicures. Trips out are currently done in staff cars but the activity coordinator said she is looking for transport so that several people can go out if they want to, and people in wheelchairs can go as well. The activity coordinator told us that she and the assistant activity coordinator are going on a training course to learn more about activities for people with dementia: they have recruited two volunteers who will run the activities that day. The NHS is paying for the activity coordinator to go on a 4-day course on chair-based activities. Two bread-making machines have been bought and staff and people in Redlands make bread every day to eat with their lunch. The activity coordinator told us that the sensory room will be fitted out in early June. She showed us that lots of photographs are taken of people doing the activities and she has bought a photo album for each resident so they can keep the pictures of themselves and their friends. The activity Care Homes for Older People Page 19 of 34 Evidence: coordinator said Im very pleased to be working here. There are some very good staff here - were all really passionate about what we do. We have fun. She told us how shes found it amazing to be bringing things out of people: for example one person is now writing, one is drawing and another painting, which none of them had done for a long time. One person we spoke to told us there is a lot going on, but as he is in a wheelchair he finds some of the activities, such as skittles, bowls and gardening difficult to join in. However, he has a computer in his room which takes up a lot of his time, and he was really pleased that the activity coordinator has encouraged him to start painting again. Another person also said there is a lot going on, some of which he enjoys, especially the church services. He and a friend play a lot of scrabble. A new catering manager has started work at Anjulita Court since we last visited. She had not previously worked in a care setting, but she said she was getting used to it, and enjoying the job. She said Its lovely here. The building is really great, the residents are nice and I like the way theyre happy to give their opinion. She added that it has been hard working with agency staff, but a second cook has been appointed and will start in 6 weeks. The kitchen was very clean and tidy. Most foods were labelled with either the use by or an opened on date. The catering manager said the food safety officer had visited and was pleased with everything, other than the catering manager had not been aware she should date-label dried foods when she decanted them from their original packaging into plastic containers, but since then she had labelled everything. The catering manager said she had spent her first week at 3 different MHA homes as her induction to the company and to learn how to cook for large numbers of older people. Since then she had done moving and handling training, and would be doing full fire safety awareness training the next day. On the Saturday following our inspection she was going on a course to learn about food for people with dementia. People choose each evening what they want to eat from the following days menu, but alternative foods are always available if people change their minds or if they do not like the choices on the menu. Most people choose to eat cereals and toast for breakfast but a cooked breakfast is prepared if people want it: one person has something cooked every day. Lunch is soup, sandwiches and a light dessert such as jelly or blancmange. The main meal is in the evening. On the day we visited, the evenings choices were gammon steak or moussaka. There is a choice of puddings, or yogurts and fresh fruit are always available. The catering manager said that special diets are catered for when needed. One person has her own menu because of her Care Homes for Older People Page 20 of 34 Evidence: medical needs. As far as possible, people with diabetes have a diabetic version of what everyone else is having, for example puddings made with sweetener rather than sugar, sugar-free jellies and so on. We spoke to two people about the meals. One said the meals are very good, with a lot of choice, and there is plenty to eat and drink. The other said the food had been excellent, but a couple of times lately the meals had not been quite as they should. This person was happy to speak to the manager about this, and had raised it at the previous evenings meeting. We saw that tables are set very nicely for meals and people were enjoying lunch. One person we spoke with said there is too much noise at mealtimes, so it is not as pleasant an experience as s/he would like it to be: staff clatter the trolley around, they shout from the kitchen, they throw the crockery about and the TV is always on. This person also said that some of the staff do not know how to serve a meal, and lean across the table in front of people: we noticed this in one of the units. Staff told us that the dining rooms are not big enough, and in the one unit that is full, some people have to eat in the lounge on over-chair tables. We discussed this with the manager, suggesting that perhaps the lounge area could be re-arranged to accommodate another table. In the unit for people with dementia, lunchtime was very calm and relaxed, and there was pleasant banter between staff and residents. Care Homes for Older People Page 21 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. People can be confident their concerns will be listened to, however staff have not received adequate training to know best practice in keeping people safe. Evidence: Both of the residents we spoke with said they would know who to talk to if they needed to complain about anything. One said I would talk to the manager, but Ive never had to - Ive no complaints. The other said s/he is happy to speak to the manager, and had raised a couple of issues at the residents/relatives meeting the previous evening. Complaints about the care their relatives were receiving had been raised by 2 families with the previous manager. These had not been dealt with and had escalated, resulting in the local authority holding strategy meetings under their safeguarding protocol. Both families had moved their relatives to other homes. The area manager told us that following the 2 complaints which had gone to the local authority, there had only been three further complaints. These were largely queries around the fees and all three had been resolved satisfactorily by the area manager. Since the change in manager, families have been more satisfied with the care their relatives are getting. The area manager said this had been shown by the fewer number of relatives coming to the relatives meeting, where previously almost every family had turned up because they had concerns. And the relatives who did attend said they no longer need a meeting every 6 weeks. Care Homes for Older People Page 22 of 34 Evidence: Since our last inspection the 2 complaints referred to above had been raised with the local authority safeguarding (SOVA) team. In both these instances, and on a 3rd occasion the previous manager had failed to report incidents to safeguarding in a timely manner. On the 3rd occasion, staff had reported a potentially serious criminal offence to the manager and she did not report it to the police or to the safeguarding team for more than 2 days. This has since been resolved satisfactorily. Safeguarding vulnerable adults from abuse is included in the induction which all staff undergo. However, staff should also receive more in-depth training, including local protocols to follow, so that all staff are able to make a referral if they need to. Staff we spoke with said they had not had this training yet, and the information about training sent to us by the manager following the inspection did not include any plans for safeguarding training, nor any numbers of staff who have already undertaken this training (see Staffing section of this report). We have made a requirement relating to this. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anjulita Court provides a very comfortable, clean, spacious home for people to live in that has been furnished and decorated to a very high standard. Evidence: Following our last inspection we wrote: This brand new building is light and airy, with lots of space for residents to walk around, and several areas for people to sit quietly or meet with friends and relatives. There are wide corridors and lifts so that all parts of the building are accessible. The building has been decorated in a modern style, and comfortably furnished, and the lounges, which have a fireplace, are already looking homely. A lot of thought and good ideas went into the builing of Anjulita Court. There are a number of additional rooms not always found in care homes. For example, there is a therapy room (which will also be a sensory room); a hairdressing salon; a lounge that is set up for watching films; a quiet room used as a chapel; the hydrotherapy pool and changing room; a quiet lounge which has computer equipment and library books; and the shop and coffee shop in the entrance hall. The entrance hall itself is large enough for entertainment to take place, with room for everyone who wants to join in. Bedrooms are large and well-furnished, but people have the opportunity to bring in Care Homes for Older People Page 24 of 34 Evidence: items of their own furniture if they wish. A married couple showed us how comfortable and personal they have made their room, with their own furniture, pictures and mementoes. The main kitchen is very well equipped, and there is a large laundry, as well as changing rooms for staff and a staff room, and offices. Most rooms (except bedrooms) have automatic lighting, and each bedroom has a sensor system that can be enabled if the persons movements need to be monitored. There is a large central courtyard which has been landscaped, including a water feature, to provide a comfortable, protected outdoor space for people to sit in. All round the building landscaped gardens include seating areas and flat paths for people to be able to walk round safely. At this inspection we saw a number of people sitting in the courtyard, and two people we spoke with said how much they enjoy being able to go out whenever they want to, to walk round the gardens. One person told us he has a problem with the doors to the garden. He (and anyone else who wants to go out) has to ask staff to open the doors when they go out, otherwise an alarm is set off. Then the doors cannot (for safety reasons) be opened from the outside, so if they slam shut while people are in the garden they have no way of getting back in, nor of attracting attention. The manager is aware of these issues. The dining areas are proving too small for the number of people who will be in each unit, demonstrated by what is happening noe in Milton (see Lifestyle section of this report). The manager said the homes benefactor has plans to extend the dining areas, without encroaching on the living room space. The home was spotlessly clean and smelt fresh throughout. This included the main kitchen which was very clean, neat and tidy. Care Homes for Older People Page 25 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. Staff are recruited well and at most times there are enough staff on duty to meet the needs of the people who live here. However, people cannot be assured that staff have received sufficient training so that they can do their jobs as well as possible. Evidence: People we spoke with made positive comments about the staff. One said Generally the staff are all very good; and another said Staff are very, very good. Everybody is very helpful. [Name] is so willing and so quick (but a bit noisy). One of the staff said Its been a challenge, but a good challenge - were all on a journey but were in it together and well get there. The home support manager said The team here is very good - all keen, hard-working, very willing and keen to see the place succeed, and nice to the residents. Managers and the activity coordinator also had positive things to say about the staff team, quoted in other areas of this report. A lot of new staff have been recruited to permanent posts, and the home has managed to cut right down on the number of agency staff it employs. One staff member said Theres been a vast improvement in the residents since we cut down on agency. The manager told us there are now 56 members of staff. The manager and area manager said that they will continue to recruit staff as they intend to have the staff in place, and trained, before they start to admit more residents. They said that 2 nurses who had left have asked to come back as they have heard the home has Care Homes for Older People Page 26 of 34 Evidence: improved. During the inspection we observed that there were sufficient staff on duty to meet the needs of the people living at Anjulita Court. However, staff in the residential unit told us that the 3 staff struggle in the mornings now there are 15 residents in the unit. They said that the dependency needs of some of the residents have increased so that at least 5 people need help with personal care, and one person needs full support with all personal care tasks. The manager agreed that dependency levels of people have changed and told us that she is looking at this. She said that she has asked the local authority for a re-assessment of one persons needs as it is probable that this person now needs nursing care. During our inspection in December the volunteer coordinator told us that she had found about 20 volunteers who help with various aspects of activities in the home. All volunteers go through a thorough recruitment process, including a Criminal Record Bureau (CRB) checks. She told us that she herself had all the right checks carried out before she was offered the job, and she felt she had a good induction which included fire, health and safety, and safeguarding training. The activity coordinator told us that she has started to recruit some relatives as volunteers. We looked at personnel records for 3 staff who have been employed since our December inspection. All the required documentation, such as references and Criminal Record Bureau check, were in place. The manager showed us that she has set up a file to make sure that recruitment is absolutely spot-on: she has virtually re-interviewed one nurse who had already been offered a post, as her employment history was not complete. The manager said that 9 carers have a National Vocational Qualification (NVQ) in care, which she worked out to be about 32 . She explained that before she arrived, training records had not been kept up to date. She showed us that she was in the process of finding staffs training certificates so that she knows what training staff have undertaken, but felt she was almost having to start from scratch. Following the inspection, the manager sent us a list of the numbers of staff who have done fire training, manual handling, infection control, food hygiene, and health and safety. This showed that by the end of June 2010 all staff should have completed fire safety and manual handling training. A large number of staff were due to do food hygiene (33) and health and safety (36) training by e-learning, however no dates were given. The manager wrote that she was trying to access infection control training. In a telephone conversation following the inspection the manager said that Care Homes for Older People Page 27 of 34 Evidence: 11 staff have done first aid training. We were not provided with information about other training which people should be doing, for example safeguarding, and care of people with dementia. We have therefore concluded that the requirement regarding staff training made at the last inspection, has not been fully met. Care Homes for Older People Page 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the management team is addressing shortfalls to ensure the home is run effectively. However, they cannot be assured that care planning and staff training are robust enough to ensure their needs are fully met. Evidence: One of the staff we spoke with volunteered that the management team is really good. The new general manager, Anna Marrah, and home support manager, Eileen Brown, both started in May 2010. They are both registered nurses and both said they work very well together, complementing each others strengths. The area manager told us she is very pleased with what they have achieved so far, and is sure that they will continue to work hard to ensure the home becomes the best it can be. She said Its a changed place. Some of the improvements had already been started by the interim manager, and these are continuing. The manager has not yet applied to CQC to be registered. The MHA quality assurance process is gradually being put in place. The manager told Care Homes for Older People Page 29 of 34 Evidence: us that monthly internal audits are carried out on medication, care plans, the kitchen, and maintenance. The area manager does monthly visits to the home as required by regulation 26, and does a full audit every 3 months. The MHA annual Standards and Values audit incorporates a residents satisfaction survey: this will be done once the home has been open for a year. There are regular resident/relatives meetings: these have been held every 6 weeks while there were so many issues, but relatives have suggested that every 3 months will be enough now that things are improving. The manager said that staff supervisions have started, but not all staff will have received supervision yet, as this is a cascading process. Eventually all staff will have supervision at least every 2 months. We will look at this again at our next inspection, to make sure this happens. A small amount of cash is held for some people who prefer not to (or are unable to) look after it themselves. At the last inspection we noted that good records are kept, and we checked the cash and records for 2 people which were both accurate. The new manager said that good records are still kept and she audits them all every week. Following the inspection we spoke to the manager who told us that tests of the fire alarm system are done weekly, and tests of the emergency lights are done monthly, as well as full tests of all the systems done regularly as required. She told us that new staff are now receiving fire safety awareness training on either their first or second day, and regular fire drills will be carried out (some have already been done) to make sure all staff are involved in a fire drill at least once a year. Some staff training in the topics involving health and safety (fire safety, food hygiene, infection control, first aid, and moving and handling) has been done, but not all staff were up to date in all these topics (see staffing section of this report). Some staff were attending moving and handling training on the day of the inspection, and another course was due to take place the following day. While we were in one of the units we saw 2 staff move a resident using a banned lift (by putting their arms under the persons armpits). The manager said she would deal with this immediately. This home is managed much better than it was, so that the quality of life for the people who live here is improving. The manager knows that there is still a long way to go, and any improvement must be sustained. Care Homes for Older People Page 30 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 31 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 7 15 Care/support plans must give sufficient information and guidance for staff, and the guidance must be followed. So that each person can be sure their individual needs are met. 31/07/2010 2 9 13 Agency nurses must be trained and competent to administer medication. So that medication is administered correctly and safely at all times. 16/07/2010 3 9 13 The provider must continue 31/07/2010 to robustly audit medication, particularly in the nursing unit. So that there is evidence that people are receiving their medication as prescribed. Care Homes for Older People Page 32 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 4 18 13 All staff must undergo training in safeguarding vulnerable adults. So they are clear about what is abuse and how and to whom it must be reported, so that residents are protected. 31/08/2010 5 38 18 All staff must undertake 31/08/2010 training in all the topics related to health and safety (that is, fire safety, infection control, first aid, food safety and moving and handling). Their practice must be regularly monitored to ensure they continue to use good practice. So that staff practices ensure that people who live at the home, and staff, are kept as safe as possible. 6 38 13 There must be a member of staff trained in first aid on duty at all times. So that first aid can be given quickly when needed. 31/08/2010 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 36 All staff should receive regular supervision. Page 33 of 34 Care Homes for Older People 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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