Care Home: Annaly House

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What the care home does well The home continues to support residents to remain well and out of hospital. Independence is encouraged, although due to resident`s long-term mental health illnesses the manager said that these residents are not likely to be able to live independently in the community. The residents are however, encouraged to pursue their own interests and activities. Staff continue to consult with residents in the life of the home and encourage residents to make choices about what they want to do. Community liaison with health and social care professionals is good and the health and social care needs of the residents are well met. The home provides comfortable and homely accommodation. The premises are kept to a good standard of cleanliness. What has improved since the last inspection? The views of stakeholders are sought which feed into the homes quality assurance system. What the care home could do better: The home must ensure that staff progress more quickly through British Sign Language Stage 1. Copies of key Health and Safety records carried out on the building should be obtained and available at inspection. CARE HOME ADULTS 18-65 Annaly House Old Church, 146a Bedford Hill London SW12 9HW Lead Inspector Davina McLaverty Unannounced Inspection 6th September 2006 10:00 Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 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 Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Annaly House Address Old Church, 146a Bedford Hill London SW12 9HW 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) 020-8673-5533 020 8673 8585 annalyhouse@signcharity.org.uk Sign The National Society for Mental Health & Deafness Mr Leroy Fitzhubert Kinlocke Care Home 6 Category(ies) of Learning disability (6), Mental Disorder, registration, with number excluding learning disability or dementia - over of places 65 years of age (6), Sensory impairment (6) Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2006 Brief Description of the Service: Annaly House is a six-bedded unit, which provides care for adults who are deaf and have mental health difficulties. It is owned and managed by Sign, which is a charitable organisation. The home is situated in a converted church in Balham (Old Church) and shares the building with the National Deaf Service. Annaly House and the National Deaf Services work as an integrated unit within Old Church due to the degree of the mental health issues, challenging behaviours and support needs of the residents. Annaly House is a self-contained unit situated on the second floor of the building. All residents have their own bedroom with sink unit. There is a communal open plan lounge /kitchenette/dining area. The main kitchen is located in the premises of the National Deaf Service on the ground floor. The home is situated in a residential area, which is in close proximity to public transport and local amenities. The home is staffed twenty-four hours a day. The residents and staff communicate using British Sign Language (BSL). A copy of the last inspection report is displayed in the home. The fees per week are £1446. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector, (supported by an interpreter who was used to communicate with the residents), carried out this unannounced inspection. The inspection started at 9.50am and concluded at 5.00pm. The inspector met all six residents but only spoke with two through the interpreter as three returned from their holiday just as the inspector was leaving, and another chose not to speak to the inspector. A number of records were examined, which included residents care plans, staff records, staff and residents meeting minutes and Health and Safety records. The communal areas of the home were seen and also one residents bedroom. Prior to the inspection taking place, questionnaires were sent out to all six residents, three health care professional’s and three relatives. Questionnaires were received from two health care professionals and two relatives. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that staff progress more quickly through British Sign Language Stage 1. Copies of key Health and Safety records carried out on the building should be obtained and available at inspection. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 6 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. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives will have information they need to make an informed choice about the home and its suitability. An organisational assessment procedure is in place, which includes visits to the home. EVIDENCE: A Statement of Purpose and Service User Guide are available in the home. Both documents contain appropriate information to support residents, their representatives and purchasers make an informed choice as to whether the home can meet the persons assessed needs. The organisation’s assessment and admissions policy includes visits to the home for the prospective resident and their representatives. Referrals usually come to the home from the hospital run by the National Deaf Services who share the same building, so that on –going support is available. The assessment procedure is thorough with several visits taking place to ensure that the home can meet the assessed needs. The manager stated that he has a lot of contact with various professionals prior to anyone’s admission. Since the last inspection, a resident who was a patient on the ward on the first floor had been admitted to the service. Adequate assessment information was seen on the residents file. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The needs of the resident are always identified and planned for with the involvement of the resident and their key worker. Residents are encouraged and expected to contribute in order to acquire skills to enhance their life. Risk assessments are incorporated into care plans. EVIDENCE: Two support plans were examined and both were seen to be satisfactorily maintained. Support plans are reviewed in consultation with the resident with both parties, if able, signing the plan. The plans seen focussed on particular areas of need for the individual and are task centred. Monthly summary updates were in evidence, again with both parties signing the document. From discussion with staff and residents, and from observations made at the time of the inspection, the view was formed that residents are encouraged to make their own decisions on their day-to-day activities. Some chose very little and spend a lot of time in their bedrooms. Staff spoke of frustrations in trying to get residents to be more proactive with their lives as several residents choose to do very little despite much encouragement. Discussion was seen to have taken place regarding this issue during staff meetings. The manager stated Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 10 that due to the severity and longevity of many of the residents mental health, progress is going to be slow and that since managing the home, he has seen a lot of positive changes in the residents e.g. three residents going on holiday, for one of them this was a real achievement as in the past the resident would refuse to go. All residents are part of the hospital Care Plan Review and are closely monitored by deaf services. Reviews were seen to be taking place with resident’s participation. One of the residents review was due the following day. Risk assessments were seen to be incorporated into the care plan and therefore were reviewed on a monthly basis. Due to the nature of this home the Commission is regularly notified of incidences that occur between residents and with staff as several residents have challenging behaviour and can at times lash out. From discussion with the manager and looking at assessment reports on file the inspector was satisfied that these incidents were due to the conditions and behaviours of the residents and that staff at the home are doing what they can to manage or minimise the risks and incidents. There are clear procedures in place for staff to follow when incidents take place. Resident’s health needs are also addressed and records were seen of visits to GP’s, dentists, opticians etc. Due to communication difficulties staff usually accompany residents on appointments withdrawing during examinations or when requested by the resident but remaining on hand. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Staff encourage residents to utilise community facilities and to be as independent as possible. Comments from residents continued to be mixed regarding the quality of food provided. EVIDENCE: Staff continue to support residents as required. Residents are encouraged to use the Bridge Day Services (a day centre specifically for deaf and hard of hearing people), where a variety of activities are offered e.g. computing, arts and crafts and trips out. Recreational activities are also available in the home e.g. board games and in the hospital on the first floor, e.g. pool, darts. One resident is currently gaining work experience at the Bridge, in their kitchen, which staff said they were enjoying. All residents are able to use public transport and five of the six residents can go out independently. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 12 One friend stated in their questionnaire that they were very happy with the support their friend received and that she was very happy living there. Another said that they would like the home to communicate with them more. Another relative said that they were extremely satisfied with the support their relative receives. In discussion with the manager he reported that residents often do not want staff to talk to their relatives and the home respected their wishes, therefore it is up to relatives to make contact with the resident themselves. During the inspection interactions between staff and residents were seen to be positive. Three staff individually spoken to were very positive about the home and the residents. Residents have unrestrictive access to all communal areas of the home. They have keys to their bedrooms Staff reported that lunch and tea are provided in the dining room in the hospital unit. Whilst this is not ideal the home was set up like this with Sign buying into this service. Residents and staff will go down at agreed times for meals. A copy of the menu was seen, which appeared varied and nutritionally balanced. A choice is always available. One resident spoken to was positive about the food served another said that there was lots that they didn’t like. The manager reported that he has regular meetings with staff in the canteen about the food and will include discussion from the residents regarding what they like to eat. The inspector noted that a couple of residents had raised the food on their quality audit form, which will be fed into the organisations quality assurance system. Facilities are available in the home to prepare meals and residents prepare their own breakfast as they wish and can help themselves to snacks throughout the day in their kitchenette/lounge. One staff reported that occasionally at weekends staff will cook an evening meal with residents who will sit together and eat. These evenings are popular and provide a social evening. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Residents receive appropriate levels of support to ensure their physical health needs are met. Systems are in place to ensure the safe administration of medication to residents. EVIDENCE: Support documentation examined showed that appropriate support was provided to ensure that individual physical health needs were met. Records of contact with various health care professionals were seen e.g. Opticians, GPs, and physiotherapists. Both health care questionnaires received raised no issues or concerns. Medication administration records were observed to be well maintained. Medication Administration sheets were seen for two residents and were satisfactorily completed. All medication coming into the home is recorded and any return of medication is returned to the pharmacy. Medication seen was appropriately stored and labelled in the medication cabinet. Two staff spoken Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 14 to said that training had been provided from an external source. Certificates were seen which confirmed this. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, a copy of which is detailed in the service user guide. A copy is also displayed on the notice board. Policies and procedures are in place to protect residents from abuse and harm. EVIDENCE: The manager stated that one complaint had been received since the last inspection, which had been investigated but not proved. Details of the complaint were recorded in the complaints book. A copy of the organisation’s adult protection policy is available to staff, as well as the organisation’s whistle blowing policy. Staff spoken to were aware of their responsibilities in respect of this procedure. A copy of the Local Authorities Protecting Vulnerable adult’s procedure was available in the home. Both residents spoken with stated that if they were not happy, they would talk to staff who would sort the problem out. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The standard of accommodation is generally good providing residents with a comfortable and homely place. The privacy of residents is protected when using the bathrooms and toilets. The home is clean, tidy and hygienic. EVIDENCE: The communal areas and bathroom area were observed to be kept in generally good decorative order at the time of the inspection. A large lounge/dining room is the main communal area in use by residents. Two toilets, bath and shower are available for resident’s use, all of which can be locked. Only one bedroom was seen which was personalised. Residents take responsibility for keeping their bedrooms tidy, although where needed, support from staff is offered. Each room has a flashing doorbell light to alert the resident that someone wants them. One resident confirmed that staff always used the bell when they wanted her. All bedrooms can be locked and residents have keys. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 17 All communal areas of the home, were found to be clean and tidy on the day of the inspection. The kitchen on the ground floor was not visited on this inspection. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Staff are clear of their roles and responsibilities. The organisation encourages staff to complete relevant training courses to support heir roles and enhance the service delivered. The home has an adequate recruitment policy in place, which protects residents. EVIDENCE: Three support staff were spoken to individually and all were clear regarding their role and what is expected of them. Residents spoken with said that they were generally satisfied with the support given and liked the staff. Concerns however, were expressed by staff regarding proposed changes to the roster. Currently there are a minimal of two staff on duty during the day and two waking night staff. The inspector was informed that the organisation is currently looking at reducing the waking night staff to one. Staff believe that this is insufficient in view of the needs of the residents as several do get up during the night and can be challenging. Staff reported that they would not feel safe if this occurred. In discussion with the manager he reported that this was being considered but to date nothing had been agreed. The Commission for Social Care must be kept informed of any proposed staffing changes. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 19 Staff members all have undertaken their NVQ level 2 qualifications and British Sign Language Stage (BSL) 1, however, all three staff spoken with had yet to achieve their BSL stage 1 qualification, which is concerning given that they had all worked in the home for over three years. In discussion with the manager he reported that he was addressing this with all staff and had set up two sessions a week whereby staff were expected to practice their signing skills. Also staff had agreed that any staff not signing when a deaf person was present would be fined fifty pence. Staff and the manager stated that this was having a positive effect. Currently the home has only one deaf staff member who was on leave at the time of the inspection. Four staff files were examined and all the information required was in place with the outcome of two CRB checks not being on file. However, confirmation was received during the inspection of the staff CRB number and outcome, which was added to the staff file. Staff meetings take place regularly as well as supervision session, which all staff said, were regular and that they found them helpful. Notes are taken at both meetings, which were seen by the inspector. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 &42 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The manager has a good understanding of the residents needs. The views of relatives, friends and other involved stakeholders are sought and are being incorporated into the quality assurance of the home. Appropriate health and safety systems are in place to ensure the safety and welfare of the residents, however, copies of these checks should be available in the home. EVIDENCE: All staff spoke positively of the manager’s style of management stating that he was “approachable, fair and encouraged and involved them in decision-making, which they all said they welcomed as it made them feel valued. The manager has completed his NVQ level 4. Staff meetings were found to take place monthly with comprehensive minutes being taken. Staff stated that they found these meetings useful as they provided a forum to discuss and raise issues as well as to share ideas. Staff who do not attend are expected to sign the minutes when read. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 21 An organisational policy on quality assurance is in place although it still is not fully operational, in that a quality audit by a manager from another service has not visited. However, the home’s manager by means of a questionnaire had sought views of residents and relatives and stakeholders. The manager stated that these comments would be collated to see what if any changes in how the service operates should take place. Residents meetings continue to take place and these can also address issues which residents are not happy with. Monthly regulation 26 visits take place with copies of the report being forwarded to the Commission. As the home shares the premises with various other body’s, Health and Safety checks for some things are carried out collectively e.g. fire drills, gas safety, and testing of the fire alarms. Copies of various checks were not seen although the manager said that all the required checks were in place. The home carries out its own visual monthly safety checks of their premises. However, records seen did not evidence monthly checks and this must be addressed as well as obtaining copies of key health and safety checks as detailed above which are carried out on the premises. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 18(1) (a) Requirement The Registered Person must inform the Commission of any proposed changes to staffing levels prior to them occurring. The Registered person must ensure that regular checks on the premises that residents have access to are carried out and recorded. Timescale for action 30/10/06 2 YA42 13(4) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA35 YA42 Good Practice Recommendations The Registered persons should review the system in place for staff achieving their BSL Stage 1 within a reasonable period of employment. The Registered Persons should obtain copies of key health and safety checks carried out on the premises to enable a full assessment of the standard to be made at the time of the inspection. Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Annaly House DS0000010165.V310452.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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