Care Home: Annabel House

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What the care home does well Information is available to help people decide whether or not the home is right for them. They have the opportunity to try out what the service offers before deciding whether or not to move in. People`s needs are assessed, so that their care can be properly planned. Residents have detailed care plans, to make sure they get the support they need in ways that suit them. Plans and risk assessments are reviewed regularly so that they are kept up to date. People get a good standard of basic personal care. They are looked after by staff that know them well, and treat them with warmth and respect. Staff give them the support they need to keep appointments with doctors and other health professionals, to help them stay healthy and well. They are able to pursue valued activities and to keep in touch with people who are important to them. They have access to a good diet and enjoy their food. Staff support them to do as much for themselves as they can, to promote their personal independence. The house is generally well maintained, decorated and furnished throughout. This means that residents can enjoy the benefit of living in a place that is clean, safe, comfortable and homely. Staff are well trained and qualified, so that they have the skills and knowledge they need to do a good job. Important checks are carried out on staff before they start work at the home. This is to make sure they are fit for the job. The home is generally well run. The Manager makes sure that she finds out what people think about what the home does, to help her plan future improvements. Important checks are carried out regularly on essential equipment, to make sure that people living and working in the home can stay safe. What has improved since the last inspection? The Manager and staff team have worked hard to meet requirements and recommendations made at the time of the last inspection. New care plans have been put in place, so that the support people get can be more "person-centred". Staff have done training in using these. Risk assessments and records have been reviewed to make sure that they are up to date. The Manager has put a maintenance and renewal programme in place to make sure that jobs that need doing around the house get done. New furniture has been bought for the lounge, and new carpets put down in the hallway. Work to redecorate the house is continuing. New furniture has also been bought for use in the garden. A good deal of work has been done around the house to make sure that it stays well maintained, for the comfort and benefit of the residents. The Registered Provider is now completing reports required under Regulation 26 (Care homes Regulations 2001), so that the work of the home is monitored appropriately. Particular efforts have been made to make written information available in picture or "easy read" versions, to try and make them easier to understand. Staff have done training and been updated on local multi-agency guidelines on safeguarding, to help ensure that residents can continue to be protected from abuse or harm. What the care home could do better: Care plans should be developed so that they include people`s personal goals. These should be clearly measurable, so that it is possible to see what is working and what is not when plans are reviewed. In the same way, people`s health action plans could be improved by setting clear goals. Doing this will help to support them to stay healthy and well. Staffing at the home needs reviewing. This is to make sure that improving the level of support available can increase the range of individual activities they enjoy. This should be clearly linked to their care plans and agreed goals, so that people get the support they need to achieve their aims. Good work already done in monitoring the quality of the service should be built on. This will make sure that the views of people using it guide future planning and development. Arrangements for formal supervision of staff need to improve. This is to ensure that they get the support they need to do their jobs well. Medication administration records should be monitored more carefully. This will help to ensure that people get their medicine in the correct amounts and at the right times. The Registered Provider should ensure that she completes all mandatory refresher training to make sure that her knowledge and skills are kept up to date. CARE HOMES FOR OLDER PEOPLE Annabel House 6 Clifton Street Stourbridge Dudley West Midlands DY8 3XR Lead Inspector Gerard Hammond Key Unannounced Inspection 11th September 2008 09:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Annabel House Address 6 Clifton Street Stourbridge Dudley West Midlands DY8 3XR 01384 397104 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs D L Braham Lisa Braham Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 9 The maximum number of service users who can be accommodated is: 9 27th September 2007 Date of last inspection Brief Description of the Service: Annabel House is registered to provide accommodation care and support care for up to 9 people with learning disabilities. Most of the people living in the home are aged over 65 years: many of them have lived together for a long time. The home is a large detached property located in a residential area, near to the Stourbridge ring road. The building is on two floors, with bedrooms located on each. It has a lounge and dining room, kitchen, laundry, office with toilet and bathing facilities available on both levels. There are seven single bedrooms and one double bedroom. The Home has a staff team of 9 people not including the Registered Manager. People should contact the home directly for current information on fees and charges. These include an additional payment for use of the home’s vehicle. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This is the service’s key inspection for the year 2008-9. We gathered information from a number of sources to help us make the judgements contained in this report. The Manager completed an Annual Quality Assurance Assessment (AQAA) and sent it to us. Surveys were posted to the residents. We made a visit to the home and met with the people who live there. We also spoke with the Manager and staff on duty. We looked at residents’ care plans and personal files, staff records and other documents. These included previous inspection reports, information that the service has sent to us (“notifications”), comments received from other people involved with the residents that do not work for the service, other documents and reports and records about health and safety. Thanks are due to the residents, Manager and staff for their co-operation, support and hospitality throughout the inspection process. What the service does well: Information is available to help people decide whether or not the home is right for them. They have the opportunity to try out what the service offers before deciding whether or not to move in. People’s needs are assessed, so that their care can be properly planned. Residents have detailed care plans, to make sure they get the support they need in ways that suit them. Plans and risk assessments are reviewed regularly so that they are kept up to date. People get a good standard of basic personal care. They are looked after by staff that know them well, and treat them with warmth and respect. Staff give them the support they need to keep appointments with doctors and other health professionals, to help them stay healthy and well. They are able to pursue valued activities and to keep in touch with people who are important to them. They have access to a good diet and enjoy their food. Staff support them to do as much for themselves as they can, to promote their personal independence. The house is generally well maintained, decorated and furnished throughout. This means that residents can enjoy the benefit of living in a place that is clean, safe, comfortable and homely. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 6 Staff are well trained and qualified, so that they have the skills and knowledge they need to do a good job. Important checks are carried out on staff before they start work at the home. This is to make sure they are fit for the job. The home is generally well run. The Manager makes sure that she finds out what people think about what the home does, to help her plan future improvements. Important checks are carried out regularly on essential equipment, to make sure that people living and working in the home can stay safe. What has improved since the last inspection? What they could do better: Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 7 Care plans should be developed so that they include people’s personal goals. These should be clearly measurable, so that it is possible to see what is working and what is not when plans are reviewed. In the same way, people’s health action plans could be improved by setting clear goals. Doing this will help to support them to stay healthy and well. Staffing at the home needs reviewing. This is to make sure that improving the level of support available can increase the range of individual activities they enjoy. This should be clearly linked to their care plans and agreed goals, so that people get the support they need to achieve their aims. Good work already done in monitoring the quality of the service should be built on. This will make sure that the views of people using it guide future planning and development. Arrangements for formal supervision of staff need to improve. This is to ensure that they get the support they need to do their jobs well. Medication administration records should be monitored more carefully. This will help to ensure that people get their medicine in the correct amounts and at the right times. The Registered Provider should ensure that she completes all mandatory refresher training to make sure that her knowledge and skills are kept up to date. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to help them decide whether or not the service is right for them. They have individual contracts, so that everyone can be clear about what the service should provide. Residents’ needs are assessed, so that their care and support can be properly planned. People get the chance to see what the home offers, before making a decision about whether or not to move in. EVIDENCE: The last inspection report shows that the home has a Statement of Purpose and Service Users’ Guide, as required. These documents were available, and residents had received copies. They also had copies of their contract / terms and conditions, which includes a separate contribution towards the use of the home’s vehicle. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 10 The majority of this group of residents have lived together in the home for many years. There has been one admission since the time of the last inspection, taking up the one remaining vacancy. Sampling of people’s personal records showed that their support needs were fully assessed, as appropriate. A new comprehensive assessment tool was introduced at the time of the last inspection. This has now been implemented. The personal file for the newest resident also contained evidence of a programme of introductory visits (including overnight stays), that took place before she decided to move in. Correspondence from family members showed that she had been supported through this process, and helped to settle in well. Standard 6 was not assessed: the home does not provide intermediate care, so this does not apply. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are generally well looked after and get the support they need to stay healthy and well. Staff ensure that they get their medication in the right amounts and at the right times. They have a good relationship with the people in their care, so that their privacy and dignity are well respected. EVIDENCE: Three residents’ personal records were sampled. The new “person-centred” format for care plans referred to in the last inspection report has now been now been implemented. Plans use the same format and a common index for all residents: this promotes consistency, so that information should be easier to find. Plans included details of individuals’ histories and background (“My life so far”) detailed needs assessments and assessments of risks. Examples of these included falls, lifting and handling, accessing the community in the minibus, shopping, going out unsupervised and going on holiday. At the time Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 12 of the last inspection requirements were made about completing risk assessments on a named individual experiencing difficulties with self injury, and on another person with regard to falls, moving and handling and tissue viability. Sampling of personal records showed that these had all been done, as required. Files all had a section in people’s care plans “Assessment of risks in my life”. These had been completed appropriately and reviewed as necessary. Plans included information about residents’ preferred daily routines, likes and dislikes -though information was somewhat limited. Plans also included information about what people are able to do for themselves and the support they need with regard to personal care and keeping healthy. Files showed that care plans are kept under regular review through completed monthly reports. These covered general / physical health, contacts with relatives or other visitors, social activities, motivation, behavioural issues, and care needs. The new care plans represent a clear improvement on the previous format. It was noted that old plans were still present on people’s files. It is recommended that these are archived or disposed of as appropriate. This is to avoid possible confusion, make sure staff use the most current plan, and to make information management easier. Efforts have been made to set some short and long term goals, but this needs some development. In order to be effective, goals should have outcomes that can be clearly measured. One person’s short-term goal showed “needs help with her cholesterol. I will encourage this by encouraging healthy food and lots of fruit”. It is suggested that the goal should be more specific. For example “reduce my cholesterol level to (target level) by (target date). Also “ensure that I eat the recommended 5 portions of fruit and vegetables each day” (or whatever is agreed). These targets both have clear time frames and aims / objectives. When plans are reviewed it should be possible to evaluate the goals set, and see what has been achieved or not. This will then help to inform future planning – is this goal the right one, or does it need to be changed / adjusted? Trying to use the SMART objective “method” can help. That is that goals are specific, measurable, achievable, realistic and time-limited. Another goal read: “likes doing lots of exercise. I will encourage this with music and dance and keep fit. It is suggested that this might be improved by saying “ I will do 30 minutes exercise five days each week” (or as agreed). It was noted that when this person’s plan was reviewed that the goals were just repeated each month, but not evaluated. When the goals were reviewed, it would have been helpful to say what exercise this person had actually been able to do, what fruit she had eaten, whether her cholesterol reading had improved, and so on. Sampling of people’s records also showed that their healthcare needs are supported through the involvement of relevant professionals, as necessary. These included GP, District Nurse, Consultant Psychiatrist, Psychologist, Cardiologist, Optician, dentist and Chiropodist. A previous requirement to refer Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 13 one resident for specialist behavioural support has now been met. Records also contained evidence of regular monitoring of people’s weights and the use of the Malnutrition Universal Screening Tool (MUST), as previously recommended. People all have a completed “Priority Screening for Health” assessment, produced by health professionals in the local Community Learning Disability Team. It is recommended that Health Action Plans be further developed to include specific goals, as with general care planning. This is so that plans promote a proactive rather than reactive strategy to supporting people to stay healthy and well (that is, what can we do that actively promotes healthy living, rather than what do we do when problems arise?). None of the residents self-administers their medication. On the day of the inspection visit to the home, a representative of the local Pharmacist completed a regular audit of medication and related practice in the home. Management of medication was judged to be generally satisfactory, with a couple of recommendations made to support good practice. Medication records included photographs of each resident, and copies of current prescriptions. The Medication Administration Record was examined: this had been completed appropriately apart from gaps relating to resident KT. The Manager was unable to say why medication had not been signed for, and undertook to investigate. The medication store was clean, tidy and secure. During the visit staff were directly observed supporting residents around the home. Support was given with warmth and friendliness, and staff and residents were clearly at ease in each other’s company. Both groups are well established, and conversations with staff showed that they have a good knowledge of their needs and preferences. Residents’ communication support needs means that it is not easy to seek their views directly in detail. Those able to responded very positively when asked if they liked the staff that look after them, and if they were well treated. Survey responses were similarly positive. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Planning of people’s activities continues to be in need of further development. This is to make sure that people are able to do the things they want, and go to places they like. Residents have access to a varied and balanced diet, so that they can enjoy their food and mealtimes. EVIDENCE: At the time of the last inspection some concerns were expressed about the range of activities available to residents on a regular basis. Recommendations were made that options for increasing the range of activities (and keeping fuller records of these) should be explored. The activity opportunities that people enjoy are a prime indicator of their quality of life. What they do should be clearly linked to their care plans and individual goals. Indeed, individual planning of activities should form a significant part of the process of setting goals. This is to make sure that that people get the support they need to do the things they want and to achieve their ambitions, however great or small. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 15 Most of the people living at Annabel House attend local day centres for structured activities for a varied number of days each week. These programmes have been an established part of people’s routines for many years. The Manager advised that the number of days that people will be able to attend is being reduced in the near future for some of the residents. This means that activity planning by the home is likely to gain an even greater significance quite soon. It has to be acknowledged that planning activities for this specific group of people carries its own set of particular challenges. People’s ages, mobility and levels of learning disability all have to be taken into account. The Manager reported that efforts were made to provide activities for people, but these were not always taken up. Clearly, when some people return home from attending activities elsewhere, they may well just prefer to relax and do very little. However, it is still difficult to make an informed judgement about the quality and range of activities people do on the basis of available records: these were sampled over a three-week period. Activities shown include household skills, music and dance, cooking, ball games, watching TV / DVD, percussion, bingo and knitting. Recorded activities away from the home showed shopping and going out to lunch. The record suggests that activities are undertaken as a group exercise and it is difficult to find evidence of individual planning. It seems that (for the period sampled) that the only people involved in shopping or going out to lunch are the ones who are not at day centres on the days these things get done. The Manager reported that all of the residents went away for a week’s holiday at Rhyll in North Wales, and that they enjoyed it very much. Residents confirmed this. People who wish to go to church are able to do so. Some do this through their local day centres; others get support from within the local community to do this. It is clear that staff have made efforts to engage people in things they enjoy doing. One person was observed knitting in the lounge, and another doing her own artwork. She clearly enjoys this and proudly displays some of the things she has done in her room. Some development is still required in this area, to make sure that activity planning becomes more person-centred, and that people’s opportunities to do things as individuals are enhanced. This may have implications for the way in which the home is staffed in the future, particularly if residents spend fewer days out at local centres. It is important that staff keep appropriately detailed records. This is essential; to make sure that future planning can be appropriately informed. As suggested above, activity plans should be clearly linked to individuals’ personal goals and evaluated when care plans are reviewed. Personal files contained evidence of contact with friends and families. Spaces to receive visitors in private are limited to individuals’ bedrooms, or negotiating the use of the dining room, lounge or office. At the time of the last inspection it was recommended that one person (who has no family contact) be referred to the local advocacy service. This was done, and an independent Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 16 advocate came to see her. The Manager advised that the resident in question has now decided that she does not wish to continue with this arrangement. Evidence was seen on her personal file that she no longer wishes to have an advocate. Staff were observed prompting people to do things for themselves, as much as they were able, so as to encourage and maintain their independence. Menu plans have now been put in place, as recommended at the last inspection. Food stocks were examined. These were plentiful and included fresh produce. The Manager reported that she had tried to introduce “taster sessions” so as to extend the range of healthy eating options for residents, but these had met with limited success. Available records showed that people have access to a sufficiently varied, balanced and nutritious diet. Residents were observed having a cooked lunch in the dining room. This was unhurried and taken in a quiet and relaxed setting. The residents said they liked their food and had what they want. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that concerns are listened to, taken seriously and acted upon. They get the support they need to help them stay safe from harm. EVIDENCE: The complaints record was examined: there are no complaints recorded and we have not received any complaints or safeguarding referrals about this service either. An updated “easy read” version of the home’s complaints procedure has been produced and is displayed. As a matter of good practice, it is recommended that information about other organisations that might offer support in making a complaint be included (e.g. social services, advocacy organisations, local ombudsman etc.). Previous inspection reports show that the service responds proactively to any complaints. At the time of the last inspection it was noted that staff had not been updated on Dudley MBC’s multi-agency guidelines “Safeguard and Protect”. This has now been done, and “read and sign” sheets were seen in evidence. Staff interviewed were able to show their understanding of relevant issues. They were able to identify the ways in which people can be abused, and to show that they knew what to do in the event of witnessing or suspecting that abuse had taken place. Staff records included checks with the Criminal Records Bureau (CRB) made before people started work. The Manager also reported that staff have done safeguarding training and training on working with people with behavioural support needs. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy the benefit of living in a house that is homely, comfortable, safe, clean and tidy. EVIDENCE: Annabel House is a large, traditional style, detached property situated in a residential area of Stourbridge. The neighbourhood is well served by public transport and there are local amenities within walking distance. As previously reported, the premises are generally well maintained to a satisfactory standard. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 19 The installation of the new wireless call system (begun at the time of the last inspection) is now completed. This is controlled from a master board in the office, and is a significant improvement for both staff and residents. At the time of the last inspection, a number of recommendations (9) were made regarding redecoration, repair and refurbishment work that needed to be done around the home. It was good to note that all of these have been dealt with. Maintenance is ongoing, and the Manager now has a maintenance and renewal plan in operation. New furniture has been provided in the lounge, the hallway redecorated and a new carpet fitted. The Manager identified that the lounge is now in need of redecoration and a new ramp required, to improve access to the house. People’s bedrooms are individual in style, generally well presented, with personal possessions and effects much in evidence. Wardrobes have been secured and radiators covered as required. It was noted that the laundry and the kitchen areas were well ordered, clean and tidy. Bedrooms do not include en-suite facilities, but there are adequate bathing and toilet facilities for the residents on both floors. It was noted that the chairs in the dining room are now in need of re-upholstering or deep cleaning to remove stains. However, the house was warm, clean and tidy, with good standards of hygiene maintained throughout. New furniture has also been purchased for use in the garden. Sadly the poor weather experienced throughout most of the summer has meant that this has not had as much usage as people would have liked. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well trained and qualified, so that they have the knowledge and skills they need to do their jobs well. Important checks are carried out before people start work, to make sure they are fit for the job. Numbers of staff should be increased to make sure that residents can be fully supported to improve their opportunities for individual activities. EVIDENCE: Concerns were expressed at the last inspection about the number of staff employed in the home. The Annual Quality Assurance Assessment shows that there are now 9 members of staff in the care team. Six of these are full-time and three part-time. Though this is an improvement on the situation at the time of the last inspection, concerns still remain about the home’s capacity to provide sufficient support for residents to enjoy an appropriate range of activity opportunities. As mentioned earlier in this report, available evidence for the activities that people currently enjoy shows that most appear to be offered on a group basis. It has previously been suggested that residents do not want to do activities. As reported above though, there are to be changes in the number of days that residents will be able to attend local day centres. This will mean that they need additional support from the home to replace the Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 21 activity opportunities they may “lose”. The situation clearly remains in need of continued review, to ensure that residents get the support they require to be able to do activities on an individual basis, ensuring that their care is properly “person-centred”. It should be acknowledged that people’s basic personal care needs continue to be well met, as previously. Consideration should be given to increasing the numbers of staff on duty during periods in the day, evenings and weekends, so that opportunities for individual activities can be improved. The Manager provided a copy of the staff training matrix. As previously reported, the home maintains a positive approach to training and supporting staff to obtain qualifications. Most of the team either hold qualifications at NVQ level 2, or are working towards obtaining these. It was noted at the time of the last inspection that there was no evidence available to show that the Owner / Registered Provider has done mandatory training. The Manager advised that she covers shifts from time to time. She was able to produce certificates to show that she has done recent training in person centred planning, risk assessment and working with people with behavioural support needs. She is joining staff for training when courses arise. Staff files were sample checked for evidence of appropriate recruitment practice. Records included completed application forms, two written references and evidence of pre-employment checks with the Criminal Records Bureau (CRB) as required. Files also had evidence of induction, training certificates. Job descriptions and contracts, health declarations and receipts for professional codes of conduct. As reported above, members of the staff team present well: they appear well motivated and knowledgeable about the people in their care, and speak positively and fondly about them. There is low “turnover” in staff, and no use is made of staff from external agencies. This promotes consistency and continuity of care for the residents. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well run for the benefit of the people living there. Some improvement is required to arrangements for formal staff supervision. This is to ensure that people get the support they need to do their jobs well. Important checks are done on essential equipment and staff are well trained. This helps to ensure that people living and working at the home can stay safe. EVIDENCE: The Registered Manager has worked at the home for many years. She began there as a care assistant, progressed to senior care worker and was promoted to Manager several years ago. She is appropriately qualified (NVQ level 4 and registered Managers Award) and has continued to update her training and professional development. She is currently working towards the IOSH health Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 23 and safety qualification, which she hopes to complete shortly. Staff say that her style of management is open and inclusive, and that they are able to raise any concerns they have with her. At the time of the last inspection it was noted that the Registered Provider had not completed reports required under Regulation 26 (Care Homes Regulations 2001). This situation has now been rectified. Copies of each months report for the past year were produced for inspection. The Manager completed and returned an Annual Quality Assurance Assessment (AQAA) in time, as requested. This could be improved by providing more detailed information about what the home is doing well and what action is being taken to develop the service. The Manager said that “customer satisfaction” surveys had been sent out to residents family members and interested parties. Twenty of these (out of twenty five sent) were returned. A sample of the comments received included “I like living here”. One person’s relative wrote that Annabel House “is like a home from home –Staff are always helpful”. Another said it was “very friendly and homely”. The responses were analysed and an action plan produced. It is recommended that the good work done in this area is continued and built on. Minutes were seen of staff meetings and residents’ meetings, which both take place on a regular basis. As previously recommended, efforts have been made to present the agenda and related information in accessible formats for the residents’ meetings. Other evidence was seen around the home (e.g. complaints and fire safety procedures) of information being presented in pictorial formats, to help those unable to read written documents. None of the residents are able to manage their finances independently. People’s individual financial records were sampled. These were appropriately maintained, with clear records of transactions, signatures and receipts. Cash held tallied with the balance shown in the accounts sampled. Accounts are monitored regularly by the Manager, and also independently audited. Sampling of staff records shows that arrangements for formal supervision need to improve to meet the recommended standard of six meetings per year. While it should be acknowledged that the relatively small size of the home means that many issues can be dealt with on a day-to-day basis, it is important that staff have regular formal opportunities for meeting with their manager. There were no available records of the Manager’s supervision meetings. Her situation is somewhat unusual, as the owner / registered provider is also her mother-inlaw. She is a regular visitor to the home and the manager said that formal issues tend to be dealt with when the Regulation 26 visits get done. Safety records were sample checked. A recent fire safety audit by the local Fire Safety Officer showed “fire precautions satisfactory”. Staff have all completed fire safety training. The fire alarm and fire fighting equipment have been serviced. Daily checks of fridge and freezer temperatures have been made and Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 24 a full record kept. Packages of food stored in the fridge were labelled with the date of opening. Accident records are appropriately maintained. As reported above, staff have completed mandatory training and requirements made at the last inspection about matters needing attention around the home have been dealt with. The COSHH store was clean, tidy and secure. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations Remove or archive superseded care plans, to ensure staff use the most up to date information to support residents. Develop care plan so that goals set have clearly measurable outcomes and keep these under review. This is so that people get the support they need to achieve their goals and aspirations. Develop health action plans to set clear goals, ensuring that support for people to stay healthy and well is proactive rather than reactive. Complete medication administration records (MAR) in full, to ensure that people get their medicine at the right time and in the right amounts. Develop residents’ activity opportunities, ensuring that they have the support they need to do the things they want and go to places they like, in accordance with their agreed personal goals. 3. 4. 5. OP8 OP9 OP12 Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 27 6. OP16 7. 8. 8. OP27 OP30 OP33 9. OP36 Develop complaints policy to include information about other agencies able to offer support. This is so that people can get the help they need to make a complaint if they wish. Review staffing arrangements to ensure that improvements can be made to the support available to people to pursue valued activities. The Registered Provider should complete mandatory training refreshers, to ensure that her knowledge and skills are kept up to date. Build on the good work already done to further develop quality assurance and monitoring in the home. This is to ensure that views of people using the service underpin its review and development. Ensure that staff receive formal supervision at least six times each year, with written records kept of each meeting. This is to ensure they get the support they need to do their jobs well. Annabel House DS0000024976.V371873.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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