Care Home: Augusta Court

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What the care home does well People who use the service have accommodation that is well maintained and decorated to a high standard. What has improved since the last inspection? The registered manager has changed the location of his office to a more central location in the home. A staff photo board has been introduced so people who use the service and visitors to the home can become familiar with staff faces and names. New staff supervision documentation is in place to make the process more user friendly. One wing has been developed for people with more severe dementia needs and it has its own kitchen, dining room and sitting room. A new fire system including door closing devices has been installed. What the care home could do better: The home does not meet people’s needs in relation to medicines. People who use the service do not have a copy of the complaints procedure. The recruitment procedures do not ensure people are protected from abuse. Staff training is not up to date. Not all records required on the day were available. Key inspection report Care homes for older people Name: Address: Augusta Court Winterbourne Road Chichester West Sussex PO19 6TT The quality rating for this care home is: One star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Gawley Date: 2 3 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • Be safe • Have the right outcomes, including clinical outcomes • Be a good experience for the people that use it • Help prevent illness, and promote healthy, independent living • Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • 3 stars – excellent • 2 stars – good • 1 star – adequate • 0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Augusta Court Winterbourne Road Chichester West Sussex PO19 6TT 01243532483/58449 01243771173 ian.eyles@anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anchor Trust Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 46 46 Over 65 0 care home 46 Date of last inspection: Brief description of the care home: D D M M Y Y Y Y Augusta Court is a care home in a residential area of Chichester providing personal care for up to 46 service users in the category of Older People. Augusta Court is a detached two-storey establishment providing 44 single flats and one double flat, each of which comprises of a bed-sitting room, kitchenette and shower room. The home has four wings, a large dining room, a conservatory, and several other sitting rooms and seating areas. One wing is now being used for those people with Care Homes for Older People Page 4 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Bar chart – design as agreed for outcome versions but headings on the left column need to be changed to Care Homes for Older People Page 5 of 23 How we did our inspection: This site visit as part of the inspection process was carried out on 23/06/09. It was undertaken by a lead inspector from the Care Quality Commission. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment (AQAA) for the inspection, when we had sent them a reminder letter. An AQAA is a self assessment and a dataset that is completed once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. We had sent to the home 15 surveys for people who use the service, four staff surveys and four professional surveys. We received in response to this completed surveys from thirteen people who use the service, four from staff and one from a health professional. Seven relatives had put comments on the surveys for people who use the service They mostly expressed satisfaction with the home. Seven people who use the service and ten staff were involved in the inspection. The community nurses involved in the home were spoken with on the telephone. Most people who use the service that we spoke with stated that they are happy in the home and that they enjoy the food. One person stated displeasure with the evening meal. The atmosphere in the home was relaxed. There are two activities coordinators employed and there is one in the home six days a week. People who use the service expressed mixed views on the activities. One survey received responded the activities are excellent and enthusiastically administered and another would like to see a more modern approach to some activities. Staff spoken with on the day to establish their experience of working in the home stated that they were happy working in the home. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Details of our findings Contents Choice of home (standards 1-6) Care Homes for Older People Page 7 of 23 Health and personal care (standards 7-11) Daily life and social activities (standards 12-15) Complaints and protection (standards 16-18) Environment (standards 19-26) Staffing (standards 27-30) Management and administration (standards 31-38) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence: A pre-admission assessment is undertaken before each admission by either the Home Manager or Deputy Home Manager, who have both had the relevant training. These assessments were seen in peoples plan and cover all areas of need. One relative commented on a survey commented that the home had done the assessment and their relative had adjusted to care very well A service user guide has been placed in all rooms but it does not contain the Care Homes for Older People Page 8 of 23 complaints procedure and not all people spoken to could state what procedure to follow. It also stated that the home provides residential care for 45 older people with mental and physical needs who can no longer be supported in their own home. It does not state clearly the dementia care that it offers. One person who uses the service stated I did not know when I came to Augusta Court that other people would have such dementia. There are very few people I can talk to The home does not offer intermediate care Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of clear care plans for everyone including for medications where needed places people at risk. Care is delivered with respect and dignity. Medications management put people at risk of not getting the medication they are prescribed Evidence: The care plans and other documents relating to five people were looked at. Two recent safeguarding referrals raised the issue of deficiencies in care planning as did the last inspection by the Commission to the service. One safeguarding referral found that records looked at were incomplete and parts had been archived and could not be retrieved. On the visit today the plan for one person requested was said to be archived and the key for the archived cupboard could not be found so this plan was not available for inspection. There was evidence in four of the plans looked at of Care Homes for Older People Page 9 of 23 improvements in care planning and recording since the last inspection. The fifth plan will be addressed below when dealing with medicines. Areas of need in the four plans and the interventions required to meet these needs were clearly stated and the plans are becoming more person centered. One plan did have an entry referring to a person by flat number rather than by name. Risk assessment is in place for areas such as moving and handling, self medication, finances, leaving the building and pressure areas. We spoke with the community nursing team and they stated generally infection control and communication with themselves from the care staff in the home has improved. Care was observed being offered to people who use the service in a respectful way in private and with dignity. There is a key worker system in place but people spoken with did not know who their key worker was. Relatives also commented in surveys that they and the people who use the service are not aware of who the key worker is. One stated “key worker not identified as stated in contract. The preferred form of address for people who use the service is recorded in their plans. The majority of medicines received into the home are recorded, stored and administered correctly. There was a controlled drug cupboard in place which was not yet attached to the wall. A contractor completed this during the visit. The cupboard contained some discontinued drugs which need to be collected by the pharmacy. It also contained some controlled drugs prescribed for a person who uses the service on May 28th this year. The first two boxes received in the home had been entered in the medicine administration chart but had not been entered into the controlled drugs book. The second two boxes received were not entered into either. Furthermore this drug had not been administered to the person as prescribed and there was not any reason for this omission recorded. The deputy manager stated that this was because they were waiting for clarification from the General Practitioner (GP). There was not any record in the care plan of the GP being consulted on this issue. He was spoken to on the telephone on 16/06/09 to discuss another drug and the controlled drug was not mentioned. The GP visited the person on 17/06/09 and any query about the controlled drug was not brought to his attention. The medication care plan dated 06/06/09 referred only to some antibiotics prescribed. This delay in seeking clarification about a prescribed drug was discussed with the registered manager. This will be a requirement of this inspection and an urgent action letter has been sent to the provider. Subsequent to the visit the GP was contacted and this drug has been discontinued. Care Homes for Older People Page 10 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the service good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle in the home does not meet the needs of all of the people who live there but there are plans in place to address this in the very near future. Nutritious meals Menus are in place but meals are sometimes are different to that listed on the menu. Evidence: There are two activities coordinators employed in the home and they were spoken with. Activities are provided six days a week. The activity programme includes music, crafts, fitness, gardening and reminiscence. There is also time to do one to one activities with people who use the service such as potting plants or doing hand massage and nail painting. Staff were observed interacting in a friendly but respectful manner with the people who use the service. Rooms are personalised with peoples own belongings and people have televisions. One person had brought in a personal computer. Surveys received and people spoken with had varied opinions on the quality of the activities. One survey received responded the activities are excellent and enthusiastically administered and another would like to see a more modern approach to some activities. There is a mini bus trip out once a month. More able people who use the service feel that there is not much on offer for them. There is a sitting room which has a large screen television for showing movies. Some people who use the service feel that this is situated a long walk away at the end of a long corridor Care Homes for Older People Page 11 of 23 and that they would prefer if there was a television in the conservatory, as there used to be for watching day to day programmes. When discussed with the registered manager he stated that the television was removed following consultation with the people who use the service. The registered manager stated that there are plans to alter the different experiences of people in the home regarding to severity of dementia. One unit upstairs is to used exclusively for those with greater need. They will have their own sitting and dining room therefore freeing up the large dining room for the people who use the service with lower need. Activities can then be tailored according to group and individual need. There was an agency chef on duty on the day with a kitchen assistant. He was not cooking the meal planned on the menu. The homes chef was on the premises doing paper work and he was spoken with. He was in the process of setting up new menus and a new ordering system to ensure that all foods required are available. One person who uses the service stated that sometimes the home runs out of various food, we are never sure of what we are going to get”. The chef was confident the new system would prevent this. Another person who uses the service stated that Food not bad, sometimes it could be improved. Of the thirteen surveys returned ,to the question Do you like the meals at the home, four replied always, seven replied usually and one person replied sometimes. There is at present high use of agency chefs to cover the second chefs role. The meal served today was appetising and nutritious. People were offered choice and people spoken with stated that they had enjoyed their lunch. Care Homes for Older People Page 12 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence: That the home is fully open to complaints was not communicated clearly from all people spoken with, there was a sense of not wanting to cause upset and safeguarding adults procedures are not followed well enough which means that people could be at risk delay as required by Regulation 37 of The Care Standards Act. A further safeguarding adults alert has been raised since the visit to the service regarding the inappropriate behaviour of staff. The registered manager acknowledges that safeguarding training is not up to date and several dates for this training have been organised for July. Staff spoken with confirmed that they had not had recent safeguarding training. Care Homes for Older People Page 13 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained and people who use the service are generally happy with the facilities Evidence: The home is well maintained and peoples room are personalised as they wish. People who use the service stated that they were happy with their rooms. A new fire system was being fitted and tested during the visit. The home is designed in four separate wings one of which is to be used for people with more advanced dementia needs which has its own sitting and dining room. All wings have a sitting room some of which have a designated use, for example, one is an art room and another is designated as a cinema room with a large screen television. There is a further large dining/sitting room and a conservatory. People sitting in the conservatory did state that it got very hot, which it was on the day of the visit. Several wheelchairs were stored in the conservatory throughout the visit which posed a risk to the health and safety of people who use the service as they reduced access to the door and also had trailing straps. This was brought to the attention of the registered manager. People spoken with stated that the cinema room is a long walk away and they sometimes go to watch a film but that they would like a television in the conservatory to watch day to day television programmes. The registered manager stated that he would consult with people again. People spoken with were generally happy with the facilities in the home and stated that their rooms are comfortable. Relatives commented that they are made welcome at the home. Care Homes for Older People Page 14 of 23 The management has a proactive infection control policy and they work closely with their own staff and external specialists, such as NHS infection control staff, to ensure that infections are minimised. Care Homes for Older People Page 15 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are on the rota in sufficient numbers to meet assessed need, Not all recruitment checks are carried out prior to commencement of employment and induction has not been completed for all staff. Evidence: The staff rota shows between five and seven carers on duty, a team leader, the deputy manager, an activities coordinator and the registered manager. There is support from an administrator, a receptionist, three housekeeping staff and a handy man. The registered manager stated that this is sufficient staff to meet the assessed needs of people who use the service. Staff spoken with stated that they do feel pressured at times to complete all care required to meet people’s needs. People who use the service spoken with stated that they did not have to wait unduly long when they call for assistance. The AQAA states that twelve of the thirty eight care staff have completed National Vocational Qualification (NVQ) Level 2 or above. The AQAA states there are recruitment policies and procedures in place. One of the newly recruited staff spoken with stated that her induction was not complete. The registered manager stated that there is now a new induction pack in place and that as result of the ongoing safeguarding investigations all staff are to be taken through induction again. Recruitment files for three staff members were looked at. All of the files had identity documentation, evidence of criminal records bureau clearance. Only two files, however had satisfactory professional references. The third file had a total of three references, but none were from the last employer and two were from friends. The dates on the employment history were incomplete and this had not been explored prior to the offer of appointment. We discussed with the registered manager the importance of Care Homes for Older People Page 16 of 23 obtaining professional references and the need to explore employment history prior to an offer of appointment. This will be a requirement of this inspection. The induction programme has not been completed for all staff and all staff are to complete a newly introduced induction. Care Homes for Older People Page 17 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of people who use the service may be adversely effected by the lack of staff training, management of medication and recruitment practices. Evidence: The home has a registered manager who has completed the NVQ Level 4 in Care and the Registered Managers Award and who has several years experience in the care industry. The home has the support of the organisation and is being supported by a project manager in the development of support plans for people who use the service. However shortfalls were identified in several aspects of the home which may adversely effect outcomes for people who use the service. Not all records requested on the day were available. The care plan for a person who was subject to a recent safeguarding adults referral was not available. The need to treat people as individuals is not fully embedded into practice. One persons needs in relation to medicines were not met and the medication care plan was not complete. The responsible individual has informed us that since the inspection a member of staff has been suspended from duty because further omissions in care and medication were highlighted by staff. Safeguarding Adults training is not up to date and procedures were not followed by staff in a recent safeguarding incident. A further incident has occurred since the visit and a further alert has been raised with West Sussex Adult Services. Care Homes for Older People Page 18 of 23 Not all incidents are notified to the Commission without delay according to Regulation 37 of The Care Standards Act. Mandatory training in first aid, food hygiene, moving and handling and infection control is not up to date. The home is complying with the requirements of a recent visit from the fire authority. The report for the environmental health authority was not available on the day of the visit. Quality assurance systems are in place. There are staff meetings and meetings with people who use the service. There are health and safety audits. The AQAA was returned to us when we sent a reminder letter. In some areas, for example medication and safeguarding there was not evidence on the visit to uphold assertions made in the AQAA. Not all people who use the service spoken with on the day feel that their comments and opinions are listened to. People are supported to manage their own money where possible. The home does not handle money for people who use the service. It holds one bank account where all the money for people who use the service is held. The computer system in the home lists the individuals whose money is in this account and the amounts held. Withdrawals are recorded and expenditure is receipted. Staff supervision is in place but not all staff spoken with felt issues raised were acted upon. We discussed this with the registered manager who stated that he feels issues raised with him are acted upon. The health and safety of people who use the service may be adversely effected by the lack of staff training, management of medication and recruitment practices Care Homes for Older People Page 19 of 23 Are there any outstanding requirements from the last inspection? Yes No x Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 23 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 The registered person to 10/07/2009 ensure that medication is administered as prescribed and any reason for omission to be clearly recorded. To fulfill the duty of care to people who use the service by giving them their prescribed medicines. 2 9 13 The registered person to ensure the recording of controlled drugs received in the home. To ensure the safe handling of controlled drugs. 10/07/2009 3 13 18 The registered person must 31/07/2009 make arrangements, by staff training or other measures, to prevent people who use the service from being harmed are placed at risk from abuse. To protect the people who use the service. 4 22 23 The registered person must ensure that suitable provision is made for Page 21 of 23 Care Homes for Older People storage facilities in the home. To ensure the health and safety of people who use the service. 5 37 17 Records required by 31/07/2009 regulation, for the protection of people who use the service and for the efficient running of the business are maintained, are up to date and are accurate. To be available to people who use the service, their representatives and The Commission. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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