Care Home: Anvil House

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What the care home does well Anvil House provides a service that values the individuality of people who live there. Interactions between staff and people in the home are good. Staff are able to provide support for people in a way that meets their complex needs. The personal and healthcare needs of people living in the home are met and relevant healthcare professionals are consulted where appropriate. Anvil House provides a comfortable, homely environment for people; it provides a good standard of furnishings and bedrooms that are decorated to reflect individual tastes. Visitors are made welcome and people are encouraged to maintain contact with families and friends. A relative spoken with said they are "very happy with the service". What has improved since the last inspection? Considerable work has been done in developing and improving record keeping; in particular care plans have been revised and the manager has produced good working care plans whilst retaining historical information that gives a background to people`s lives.The manager has developed management strategies for people who present behaviour that challenges the service and all staff have received training that will ensure the management strategies are implemented consistently by the staff team. Credit must be given to the manager and the staff team for addressing and making improvements in all areas where requirements were made at the last key inspection. Some areas throughout the home have been redecorated and in general the premises look fresh and clean. What the care home could do better: The management team seek the views of people using the service and their relatives. The Quality Assurance process needs to be further developed so that information obtained from this process is collated into a report that forms the basis of a development plan for the home. CARE HOME ADULTS 18-65 Anvil House 199 Perry Street Billericay Essex CM12 0NX Lead Inspector Ray Finney Unannounced Inspection 10th December 2007 09:30 Anvil House DS0000070234.V356748.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 Anvil House DS0000070234.V356748.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. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Anvil House Address 199 Perry Street Billericay Essex CM12 0NX 01277 633950 01277 633375 harkwright@grooms-shaftsbury.org.uk www.grooms-shaftesbury.org.uk Grooms-Shaftesbury 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) Post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18/12/06 Brief Description of the Service: Anvil House is a two storey detached property set in a quiet residential area of Billericay and situated close to local amenities including shops and restaurants. The home provides care and accommodation for seven adults with learning disabilities. There are seven single bedrooms in Anvil House and communal areas include a lounge, dining room and conservatory. The grounds and garden are well maintained and accessible to people living in the home. There is parking available to the front of the premises. The home charges between £950.00 and £1,700.00 a week for the service they provide. This information was given to us in December 2007. Information about the home can be obtained by contacting the manager. Inspection reports are available from the home and from the CSCI website www.csci.org.uk Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as menus, staff rotas, care plans and staff files. An Annual Quality Assurance Assessment (AQAA) with information about the home was completed by the manager. Throughout the report this document will be referred to as the AQAA. Relatives spoken with gave positive feedback about the service. A visit to the home took place on 10th December 2007 and included a tour of the premises, discussions with the manager, members of staff and a visiting relative. People living in the home have complex needs and are unable to communicate verbally, although the inspector was able to have some communication based around facial expressions and gestures. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day of the inspection the atmosphere in the home was calm and relaxed and the inspector was given every assistance from the manager and the staff team. What the service does well: What has improved since the last inspection? Considerable work has been done in developing and improving record keeping; in particular care plans have been revised and the manager has produced good working care plans whilst retaining historical information that gives a background to people’s lives. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 6 The manager has developed management strategies for people who present behaviour that challenges the service and all staff have received training that will ensure the management strategies are implemented consistently by the staff team. Credit must be given to the manager and the staff team for addressing and making improvements in all areas where requirements were made at the last key inspection. Some areas throughout the home have been redecorated and in general the premises look fresh and clean. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Anvil House DS0000070234.V356748.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 Anvil House DS0000070234.V356748.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to live at Anvil House receive sufficient information about the home and may be confident their needs will be assessed before admission. EVIDENCE: Before the inspection, the manager sent us and updated Statement of Purpose, a Service User Guide, a Resident Contract and a copy of the updated complaints procedure. The Service User Guide is in a pictorial format. A sample of records examined contain a ‘Charter of Rights’ and copies of the Service User Guide and the Statement of Purpose. The manager said that, although the Service User Guide has been updated, they are looking at ways to further improve the format taking people’s complex communication needs and cognitive abilities into account. People using the service may be confident that they will receive sufficient information about the home before they move in. There is a process in place for carrying out a pre-admission assessment for anyone wishing to move into Anvil House. The AQAA states, “Reports will be requested from Day Centres and other Professionals in order to assess individual’s needs. An initial care plan and risk assessment will be worked out with the help of the family and the social worker. Since most of our residents are non-verbal, every effort will be made to interpret the individual’s view of Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 9 the placement and also the views of other residents.” Although there have been no new admissions for some time, the manager is able to describe and explain the pre-admission assessment process. A sample of two care plans examined confirm that a comprehensive pre-admission assessment is carried out. Prospective residents may be confident that the home will assess their needs thoroughly before offering them a service. The AQAA also states that the process includes trial visits and a transitional process. “Several visits will be arranged for the prospective resident to see Anvil House with their social worker, family or advocate. These will extend to a meal, a full day and then a long weekend. This gives time to see if the individual is happy with the placement and is accepted by other residents. A visit will be made by Anvil House staff members to the individual’s current home to see them in their daily environment.” Records examined confirm that there are contracts on file signed by representatives of people in the home. People living in Anvil House have complex needs associated with learning disabilities. No one living there has the capacity to read or understand contracts, therefore relatives act on their behalf. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Anvil House have care plans and risk assessments in place that ensure their needs are met. They are supported to make decisions about their lives and to take risks within their capacity to understand. EVIDENCE: The AQAA states “Our residents are non-verbal. Staff know them well and understand their sign and body language. We liaise regularly with family and other professionals to ensure we have understood resident needs and preferences. Each resident has a care plan which is reviewed at an annual review”. On the day of the inspection two care plans were examined in detail. There have been significant improvements in care plans since last inspection. Historical and background information is kept in a large, well organised file. The ‘Working Care Plan’ is in a separate file with clearly set out information. Care plans are written in clear language from the point of view of the resident. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 11 Key information is clear and includes people’s likes and dislikes. Goals have been identified for each individual and information is up to date and reviewed regularly. One care plan contains well detailed management strategies giving clear guidelines to staff around non-physical means of de-escalating challenging behaviour and appropriate physical intervention techniques that may also need to be employed. Techniques have been devised and agreed in conjunction with the ‘Behaviour Therapy team’, the management and staff of Anvil House. Strategies include putting boundaries in place and the manager is able to explain how these strategies have improved the lifestyle of people living in the home and the staff team supporting them. Care plans in place include an eating plan, drinking plan, continence needs, bathing/showering plan. Care plans explain when encouragement is needed in the form of prompts and there are sufficient details to ensure staff are guided to carry out care needs consistently. People living in the home and their relatives may be confident staff receive appropriate guidance from the care plans to ensure people’s needs and wishes are met. The manager explained that, despite challenges around communication, every effort is made to ensure people living in Anvil House are supported to make choices. The AQAA states, “Each resident chooses the colour scheme for their own bedroom. If they cannot use a colour chart, a number of items of different coloured clothing are laid out for them to indicate a preference”. The manager also explained that “Residents have regular meetings in which pictures are used to help them express preferences for holidays, outings, meals and TV programmes. Books of pictures are kept which are used to aid communication such as pictures of food to help residents choose what they want at a restaurant or for a take-away.” Picture books hat were examined contain a variety of pictures that would assist people to make choices. Minutes are kept of meetings with residents, which demonstrate how staff help support people to make choices. Records examined confirm there are comprehensive risk assessments in place covering all areas of risk including kitchen and food hygiene, bathing and personal care, ‘out and about’ (road safety, stranger danger, lack of social awareness, hot weather), money management, using public transport, leisure activities, behaviour towards other residents/staff/visitors, epilepsy management, medication, physical health and mental health. The risk assessment looks at each area of risk, identifies the risk and details what actions must be taken to minimise the risk. Care plans and risk assessments use positive language, whilst clearly identifying people’s rights and responsibilities. The AQAA states, “An updated care plan and risk Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 12 assessment has been created for one resident and this will be used as a model for all the other residents”. The level of detail in the care plans is good and should ensure that people living in the home will be supported in a consistent manner and in ways that they like. Observations on the day of the inspection confirm that staff on duty support people in the home calmly and were seen to intervene sensitively to prevent challenging behaviours escalating. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Anvil House can expect to have opportunities to participate in activities that are appropriate to their needs and to be supported to build and maintain relationships. People can expect to be offered a varied diet that provides them with choice. EVIDENCE: People living in Anvil House have complex needs and no one has the capacity to go to work. The AQAA states that people “have the opportunity to go to a Day Centre, but for those who choose not to, a plan of daily activities has been worked out”. Activities include walks and visits to local parks and visitor attractions, swimming, ice-skating, cinema, crazy golf and bowling. A list of activities for the month is on the residents’ notice board. Photographs were seen that confirm people take part in a range of activities. Care plans examined contain activity planners with activities that include sensory Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 14 sessions, health & beauty, film club, communication, IT group and classical music. On the day of the inspection four people were out at day services. The manager said that these residents use day services from Monday to Friday. All the residents who were not out at the Day Service were going to a Christmas social activity at the local church. A relative who was also going with them spoke with the inspector and is very positive about how their relative is supported. The relative is complimentary about the lifestyle provided by the service and “cannot fault it”. The manager is able to demonstrate a good knowledge of the specific needs of people living in the home and also the challenges associated with meeting the social needs of people with complex and challenging behaviours. Until the current manager took up the post earlier this year, the service had been without a manager for some time. As was previously reported, this had a significant impact on how people were supported and on staff morale. The AQAA acknowledges these difficulties and states “Because of lack of management support over the past year, staff have maintained and worked within current care plans and guidelines for each resident but have not taken any significant steps to develop residents’ lifestyles. The home was already well set up to provide a good lifestyle, but the situation had not moved on. Now that we have a full staff, the development of key working through inhouse and external training will undoubtedly improve their ability to support residents in the lifestyle of their choice.” Records examined confirm that people are supported to use facilities in the local community. The AQAA states that people are supported to enjoy “Visits to restaurants, take-away nights, dance evenings and craft activities. Saturday afternoon is particularly set aside for social outings. Contacts with local churches enable residents to take part in church activities such as services and coffee mornings according to the choice and ability of the individual”. Care plans confirm that there is input from relatives in the decision making process. One relative spoken with said that they are consulted and are always kept up to date with what is going on. The complex needs and behaviours of the people living in Anvil Lodge make it difficult for them to be involved in many of the daily routines. Access to the kitchen is limited because of the risks around preparing food and cooking. However, the manager explained that they encourage people to watch meals being prepared by using a safety gate so that the door does not need to be closed when staff are using knives or hot pots and pans. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 15 People living in Anvil House are unable to say what kind of food they want. The AQAA states that menus are planned on the basis of people’s observed preferences and are combined with the principles of healthy eating. The manager said that one person prefers to eat their meals in their room rather than the communal dining room and this is recorded in their care plan. The dining room was observed to be a pleasant, modern room with plenty of space for the people living in the home and the staff who support them. Care plans examined contain details of people’s preferences and needs around food. Overall, the dining experience is good for people living in Anvil House. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect to receive personal and healthcare support that meets their needs. Anvil House has systems in place to ensure the safe administration of medication and the protection of people living there. EVIDENCE: Care plans examined contain good detail about the way people need to be supported. There is sufficient detail and background information in the care plans to ensure staff are guided to provide personal care in the way that people wish. Observations throughout the inspection confirm that staff on duty treat people with sensitivity and respect. The AQAA states, “All residents are registered at a local GP surgery where the needs of our residents are understood. Staff support residents to attend the surgery or other medical appointments and these are recorded in resident files. Residents are registered with a dentist and an optician whom they see at regular intervals”. This information was confirmed in the sample of care plans examined. There is also evidence of input from the local learning disability Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 17 psychiatric department. Specific health needs around issues such as cancer and diabetes are met at the appropriate National Health Service facilities. The service has a robust policy and procedure around the management of medication. There is a monitored dose system in place; no one living in the home has the capacity to self medicate. The AQAA states that staff have “an in-house medication induction” which is “backed up by external training from a recognised trainer”. In addition, records show that staff receive additional training around specialist healthcare needs such as the administration of diazepam in the management of epilepsy. Records examined confirm that staff have received training from the Epilepsy nurse on the administration of rectal diazepam. The manager said that “medication has been made a mandatory item at staff meetings so that any problems can be thoroughly explored and solutions found. It is an opportunity to remind staff of the serious responsibility of administering medication”. A notification was made to the Commission of a medication error regarding a dose of medication. The manager explained that they have reorganised the storage of medication to eliminate the risk of a similar error occurring. The storage of medication was examined. Medication is stored in a well organised, locked metal cupboard and there are separate boxes clearly labelled with people’s names. Recording is also good. Medication Administration Record (MAR) sheets examined are all completed appropriately; MAR sheets have photographs of the people they relate to so that the possibility of errors is reduced. The manager was able to demonstrate an awareness of the correct storage and recording of controlled drugs. Overall the process for the storage and administration of medication has been improved; this more robust system should ensure people living in the home are safeguarded. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to an effective and understandable complaints procedure that ensures that they are listened to and there are procedures in place to protect the people who live there. EVIDENCE: Prior to the inspection, a copy of the updated complaints procedure was sent to us. The manager also has provided the Commission with full details of a complaint received from relatives. Full explanations of all the issues were submitted, together with supporting evidence. The AQAA states “Concerns and Complaints are welcomed at Anvil House as a means of improving the service and are dealt with promptly according to organisational procedure. Because we have a good relationship with families most concerns can be dealt with very simply and straightforwardly”. On the day of the inspection the manager was able to demonstrate a good knowledge of her responsibilities around dealing with complaints in an open and professional manner. Records examined confirm that minor concerns are documented as well as any more significant complaints and the recording is good. People can be confident that there is a robust process in place for dealing with complaints and any concerns they may have will be taken seriously and acted upon. In the AQAA the manager states that a number of issues have arisen at Anvil House in the past year which were not resolved because of the absence of a Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 19 manager or deputy manager at the time. Some challenging behaviours had caused an injury that was referred to the local authority under Protection of Vulnerable Adults (POVA) procedures. The AQAA states that “this POVA was dealt with appropriately and agreed risk assessments were put in place. The reporting of incidents is now very thorough and training of staff in managing challenging behaviour has taken place”. The incident was discussed with the manager, who is able to demonstrate the measures that have been put in place to prevent similar incidents occurring. The manager said, “The staff are aware of the need to keep residents safe so touch-pad locks have been put on the laundry and kitchen doors and security gates have been installed to prevent residents from wandering into areas where there might be danger without excluding them from contact with staff.” A tour of the premises confirms that the gate across kitchen doorway is used when any cooking or food preparation is being carried out. The kettle is emptied and kept in a cupboard to reduce risks associated with behaviours that challenge the service. Similarly knives and other kitchen equipment that may pose a risk to vulnerable people are kept in a locked cupboard. The manager stated that all staff have received training on Protection of Vulnerable Adults delivered by the local authority and staff records examined confirm that this training has taken place. Overall people living in Anvil House are safeguarded by staff following the robust procedures now in place. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people living in Anvil House benefit from a comfortable environment that is well maintained and clean. EVIDENCE: The AQAA states that “Anvil House is an attractive and well decorated home in a residential street. Each resident’s room is nicely decorated in a colour scheme of the resident’s choice”. A tour of the premises confirms people’s rooms are individually decorated to a good standard and there is evidence of personal possessions such as photographs. There is a large, pleasant lounge with good quality furnishings. One person who was sitting in the lounge watching television appeared comfortable and relaxed and smiled at the inspector and indicated that they are happy. There is a large, enclosed rear garden that is accessible through patio doors. Although it was cold on the day of the inspection and people were relaxing indoors, the manager said the garden is enjoyed by people living in Anvil Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 21 House. Two people were relaxing in the conservatory watching a film with a member of staff. One person indicated that they were looking forward to a relative coming later. The downstairs bathroom has an assisted bath and again this room is decorated to a very high standard. Some thought has gone into the décor with a revolving mirror ball on the ceiling that reflects light on to some mirror tiles on the walls. The effect is relaxing and is designed to enhance the bathing experience for people living there. There is a second bathroom and a separate shower room upstairs that are pleasant, clean and well maintained. The AQAA states that Anvil House “maintains a high standard of hygiene and is free from unpleasant odours in spite of having to deal with a level of incontinence. Carpets have been professionally cleaned. New lights have been installed in the kitchen. A new washing machine has been purchased”. A tour of the premises confirms that the kitchen is clean; the laundry room is suitable for the size of the home and has impervious flooring that is kept clean. There are no odours throughout the premises. People can be assured that they are protected by the infection control measures followed by staff. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Anvil House benefit from a competent, well trained staff team. The recruitment procedure in the home provides the safeguards that ensure appropriate staff are employed. EVIDENCE: Information provided in the AQAA indicates that, out of a full staff team of twelve permanent care staff, six people have completed a National Vocational Qualification at level 2 or level 3. The manager and the deputy manager both have attained the Registered Managers Award and all senior staff have NVQ level 3. The manager is also an NVQ assessor. Rotas show that there is a minimum of three members of staff on duty and sometimes four. Night-time cover consists of one wake member of staff, one sleep-in and one on call so three people are always available if needed. The manager explained that considerable efforts have been put in to recruitment over the past few months and Anvil House now has a full staff team and use of agency has been reduced to a minimum. People living there Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 23 now benefit from being supported with more consistency by a well qualified staff team. On a tour of the premises, staff were observed to interact calmly and sensitively with people living in the home. A sample of two staff files examined contain all the documentation required, including two written references, proof of identity, Criminal Record Bureau enhanced disclosures, photographs and a completed application form. The manager was able to demonstrate a good awareness of the importance of a robust recruitment process so that people are supported by good staff who have been recruited appropriately. Evidence was noted in the personnel records examined of Grooms-Shaftsbury induction and code of practice and an induction to procedures around medication. Records examined confirm that staff have received training that includes epilepsy awareness, health & safety, fire safety, food hygiene, manual handling and first aid. In addition staff have ‘Basic Steps’ training which relates specifically to working with people with learning disabilities. The AQAA states that refresher training is planned in the coming year as well as training in areas specifically relevant to the service user group such as training about autism. Overall the evidence examined indicates that people living at Anvil House are supported by a well trained staff team. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is competently managed and run in the best interests of the people who live there. The health and safety of individuals living and working in the home is promoted and protected. EVIDENCE: The AQAA received from manager is completed with a good level of detail and the information in it is well supported by the evidence examined on the day of the inspection. The manager spoke with knowledge and confidence about the needs of the people living in Anvil Lodge and is able to demonstrate measures that have been taken in the past year since she has been in post to make improvements to the service. Discussion with the manager confirms that she has a number of years management experience in a variety of care settings. As previously stated, the Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 25 manger and deputy both have attained the Registered Managers Award. The AQAA states that “there is also a new senior care worker appointed to complete the management team”. Since the last inspection, significant improvements to the way the home is being managed are evident. Requirements made at the last inspection have been addressed. Sufficient evidence was presented to confirm that the management team actively seek the views of people living in the home and their relatives and act on the information that they receive. The manager recognises that they have not yet been able to produce a management plan for the service because of the other issues that they have been dealing with over the past year. A discussion with the manager confirmed that she is aware of the need to develop the Quality Assurance process further but felt that it was imperative for the safety and well-being of the people living in the home to prioritise the work that needed to be done around care planning, staff training and management strategies around challenging behaviours. The AQAA states that the plans or improvement in the coming year are “to ensure that residents are able to contribute to the development and direction of the home, by listening to their expressed views and needs and consulting their families and advocates. We will do this by developing the residents’ meetings and holding a residents’ Annual General Meeting, the results of which will contribute to the annual development plan for the home”. Records examined confirm that Health & Safety checks are being carried out. Water temperatures are checked weekly. Fire systems including automatic door closures and emergency lights are also checked weekly. There is a record of fire evacuation drills that includes which members of staff take part. The manager confirmed that drills are planned so that staff who have not taken part in a previous drill are included the next time. People living and working in the home may be confident that they will be protected by the processes that are followed around matters relating to Health & Safety. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 26 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 X 4 3 5 3 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 2 X X 3 X Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 27 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. Refer to Standard YA39 Good Practice Recommendations The manager should continue to develop the Quality Assurance system so that when they seek the views of people living in the home and other interested parties, the information is used to form a development plan for the service. Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Anvil House DS0000070234.V356748.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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