Care Home: St Anne`s, Saltash

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What the care home does well The registered manager and staff are continuing to develop the processes and services at the home to comply with good practice, standards and regulations. There is evidence of good communication systems to include service user and staff meetings. Service users stated that they felt safe, living as individuals within a group living setting. St. Annes has been awarded the Anchor Housing national quality assurance scheme Hospitality Assured. What has improved since the last inspection? The home continues to provide a good standard of care and all concerned have to work hard to maintain this position. Staff remain enthusiastic and were observed to be diligently going about their duties. The total number of staff in possession of an NVQ is 88 per cent. New staff are enrolled on these courses. Additional training courses are arranged at regular intervals and policies and procedures have been reviewed and updated. On going maintenance and decoration of the home keeps the premises in good order. The overall appearance of the home, and the grounds, are maintained to high standards. Training opportunities to include induction training is of a high standard. Comprehensive new planning for care has been introduced. The rotas have been changed to incorporate 2 team leaders on duty at the same time. This allows one to concentrate on medication systems whilst the other can lead the care team. Night staff have been increased. Key workers are no longer required to maintain laundry tasks as two laundresses are now employed. Housekeeper hours have been extended. Two staff are dedicated to providing activities thus enhancing the opportunities for service users. What the care home could do better: No requirements nor specific recommendations are made in response to this inspection. Key inspection report Care homes for older people Name: Address: St Anne`s, Saltash Plougastel Drive Callington Road Saltash Cornwall PL12 6DX     The quality rating for this care home is:   three star excellent 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: Michael Dennis     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: St Anne`s, Saltash Plougastel Drive Callington Road Saltash Cornwall PL12 6DX 01752847001 01752847951 gina.shiers@anchor.org.uk www.anchor.org.uk Anchor Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Georgina Mary Shiers Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Service users to include up to 28 adults of old age (OP) Service users to include up to 3 adults aged over 50 years with a physical disability (PD) Service users to include up to 5 adults aged over 65 years with a physical disability (PD[E]) The maximum number of service users who can be accommodated is 33. The registered person may provide the following category of service only: Care home providing personal care only-Code OP to service users of either gender whose promary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum 33 places Physical disabilityCare Homes for Older People Page 4 of 26 Over 65 0 33 0 6 0 5 Code PD- maximum 6 places Dementia- Code DE- maximum 6 places Total number of service users not to exceed a maximum of 28 Date of last inspection Brief description of the care home St Annes is a purpose built home belonging to the Anchor Trust. It provides care and accommodation for elderly people in individual rooms that are equipped to promote independence, whilst offering communal facilities, meals and activities. It is situated in a central residential area of Saltash, next to the Health Centre, library and leisure centre. Whilst too far for most service users to walk to the main shopping street in Saltash, there are small local shops and facilities near by. The home is next to a road with public transport services. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on the 14th.April 2010 over a 7 hour period of time. We met with the Care Manager, staff on duty and a number of service users. During the course of the inspection we observed the service users being attended to by staff in a courteous and professional manner. We spoke with and case tracked 3 service users. We also received a number of surveys from staff and service users. Service users all confirmed that St.Annes was their chosen home. All were united in saying that they were perfectly content with the services provided and could not think of anywhere else that they would rather be except for back in their own homes. They told us that they were well cared for by both the registered manager and staff alike. Their privacy and dignity was respected at all times. (this was observed to be the case throughout the inspection). They all complimented the food provided and stated that alternatives are provided as required. Each service user was asked if they were happy with their lifestyle. A common theme emerged. They told us that visitors were welcomed and that they had frequent contact with friends and relatives, who would Care Homes for Older People Page 6 of 26 often take them out. They stated that the staff also provided opportunities for outings, activities and interests. An activities co-ordinator is employed and daily events are publicised on a notice board. Based on observation and comments made, service users do not spend large amounts of time sitting in the communal lounge. They prefer the privacy of their own rooms where they entertain visiting guests or friends made within the home itself. Meal times and attendance of activities appear to be the main social gathering points. Those spoken with all seemed to have an interest to occupy their time. They were unanimous in stating that they felt safe at this home. All were aware of the complaints procedure should the need arise to use it. They stated that the care they received was of a high standard. They further commented that the registered manager and staff were quick to access other health professionals when the need arose. Service users informed us that their expectations of being in a care home were being fully met. They expressed satisfaction with all aspects of the home. We inspected various records, policies and procedures and found them all to be of a satisfactory standard and in compliance with the regulations. The premises were seen to be clean, tidy and well furbished. Care Homes for Older People Page 7 of 26 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. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Information concerning the home is made available. Service users are fully assessed prior to admission to the home. Prospective service users and relatives are afforded the opportunity to visit the home to assess its suitability as to meeting their needs. This home does not provide Intermediate Care Evidence: Up to date Statements of Purpose and Service User Guides were readily available. These documents can also be produced in large print, Braille and on audio tapes if required. Service users confirmed a knowledge of these documents and copies were Care Homes for Older People Page 10 of 26 Evidence: seen to be in each bedroom. These documents have very recently been reviewed and updated. Three service user files were inspected and case tracked. All contained information pertaining to pre-admission assessment and copies of contracts etc. The registered manager or one of the Care Managers visit prospective service users prior to admission to complete the assessment process. The process will include information received from other agencies to assist in appropriate admissions to the home. Prospective service users are invited to see the home and are involved in the completion of the dependency assessment documents. They are asked to complete a comprehensive questionnaire/check list entitled Is this home right for me. The management team at the home ensure the published inspection reports are available to service users and visitors and are discussed at staff meetings. Policy documents indicate that prospective service users can visit the home before making the decision to move in. Standard 6 is not applicable as the home does not provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health care needs of service users are identified, planned for and met. Service users are treated with dignity and respect. The standard of care planning set is high and is being maintained. Medication administration is followed in accordance to policies and procedures. End of life care is seen as important. Evidence: From inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of service users files, and in discussions it is evident that St. Annes encourages service users and their representatives to express their views in the formation of their care plans. The care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. Care Homes for Older People Page 12 of 26 Evidence: New care plan documentation has been developed and introduced during the past year which details all care required and given, in detail. It requires that all staff have to be involved by way of observing and recording the daily life, care and requirements of each service user. Daily evaluations are made and recorded. This provides a good trail of events and lifestyle. Alert sheets are generated as necessary as part of the process. Health needs are met by the staff at the home and by external professionals to a high standard. Records of all health professional visits are recorded in detail. Staff were observed to treat service users with respect and it was noted that staff knocked at bathroom and bedroom doors before entering. General practitioners examine and treat all service users in the privacy of their own bedrooms. Medication practices are conducted appropriately. Records are up to date. We inspected the controlled drugs. An audit was undertaken and found to be correct. The quantities of drugs held were confirmed by the controlled drugs register. End of life care is given a high priority. Staff complete a four month (3 day a week) training course to equip them with the necessary skills to manage this sensitive and difficult time in peoples lives. It is reported that good links exist between the home and McMillan nurses. The Liverpool Pathway training for end of life is now being implemented. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The routines of daily living and activities made available are flexible and varied. Service users are in control over their lives. Service users receive visitors at any reasonable time throughout the day Service users dietary needs are well catered for with a balanced and varied selection of food and drink available that meets tastes, and choices. Evidence: The routines of daily living within the home appear to be flexible to suit individual preferences. The home will offer various activities including trips out. Staff were observed to be interacting with service users throughout the inspection whilst being engaged in various activities and interests. A full daily program of events is publicised. Service users do mix in communal areas but many prefer to stay in their rooms, entertaining friends within the home and outside visitors. Those spoken with claimed to be quite satisfied with their general routines, which included personal interests and Care Homes for Older People Page 14 of 26 Evidence: hobbies. A good rapport with staff exists. The visitors book indicated that a steady stream of visitors attend the home. This was also evidenced by the number of visitors present on the day of inspection. Service users are able to make informed decisions regarding their lifestyle, supported by staff as required. Service users appear to receive a varied, appealing and nutritious diet suited to individual needs, likes and requirements. The meal looked appetising and service users were seen to be enjoying it in a social manner. Portions were of a good size and suited to the individual. The majority of service users took lunch in the dining room at one of the two sittings. Special diets are catered for and choices are available. Hot and cold drinks are offered and available throughout night and day. We had conversations with service users and their comments are detailed in the summary of this report. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is well publicised and would be used when required. The registered persons ensure that service users are protected from all forms of abuse with staff having knowledge through training of Adult Protection issues which helps to protect service users. Evidence: The complaints procedure containing the Commissions contact number and address and that of the Department of Adult Care Support was displayed in the home and is detailed in the service users guide. The registered manager and staff ensure that dayto-day control and regular contact with service users provided the opportunity to monitor standards. The registered manager has provided appropriate Protection policy, staff training and procedures. Many staff have also received adult abuse training to B.Tec. standards. There is a policy regarding staff accepting gifts from service users and precluding staff involvement in the making or benefiting from service users wills. The homes insurance provides for service users to make claims on personal items and for public liability. The home provides appropriate records regarding finances and items held on behalf of service users. Care Homes for Older People Page 16 of 26 Evidence: The Annual Quality Assurance Assessment told us that there have been eleven complaints registered in the past year. We looked at the content of these complaints and found they were all minor in substance regarding daily living events. We noted that they were all quickly resolved to the satisfaction of service users. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The location and layout of the home is suitable for its stated purpose and provides a safe and well maintained environment. Suitable equipment is provided to meet service users needs. Bedrooms are well furnished and contain their occupants personal affects. The home was clean, hygienic and free from offensive odours providing an attractive and homely place to live. Evidence: The location and design of the home is good, situated near some of the towns facilities and on a level site. The home offers level access, a passenger lift, specialist bathing equipment, pressure relieving equipment, call bell system, moving and handling aids and a variety of grab rails are provided. There are en suite bedrooms with showers in all rooms with additional assisted bathing facilities and toilets as well. The communal spaces are well maintained and furnished. There is a well-maintained garden for use in good weather and an upstairs vantage point where service users like to sit and observe the outside world. Care Homes for Older People Page 18 of 26 Evidence: Service users informed us that they considered their accommodation to be of a high standard Rooms have been refurbished throughout the past 2 years. Full size refrigerators have been installed in all rooms and the en suite facilities updated. General maintenance is ongoing. New furniture has been provided to garden areas. The home presented as being very clean, hygienic and well cared for. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment policies and procedures are implemented. All staff are supported and Inducted through training opportunities. A positive number of staff are on duty to meet the service users needs. Evidence: The staffing complement of the home consists of, Registered Manager, 2 Care Managers, 11 Team Leaders, 19 Care Assistants, 2 Laundry staff, 4 Housekeepers, 2 Administrators, Maintenance person, 2 Activity Coordinators, Chef Manager, 2 Deputy Chef Managers, 2 Catering Assistants. The staff rota indicated that there were, on duty at the time of inspection, a Care Manager, 3 Team Leaders, 3 Care Assistants, Housekeeper, Laundress, 2 Chefs, Administrator and maintenance person. At night at least a Team Leader and 2 Care Assistants. The registered manager has a commitment to providing a trained workforce and Care Homes for Older People Page 20 of 26 Evidence: individual staff files contain training schedules, 88 per cent of staff have achieved an NVQ level 2 and above. Staff training has also been achieved in food hygiene, moving and handling, first aid, infection control, health and safety and associated topics to provide for the welfare of service users. The induction records for individual staff are signed and dated. There is a stable staff team that presents a low sickness record or staff turnover. Recruitment procedures were inspected. It was seen that all staff complete application forms, have interviews, references and CRB/POVA checks sourced. The staff spoken to were observed to exhibit appropriate attitudes in their interactions with service users and a positive regard for service users welfare. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and staff of St. Annes strive to maintain and improve a good quality of care and lifestyle for the service users and promote their health, safety and welfare. Evidence: The registered manager has appropriate experience and has completed the Registered Managers Award. She is also an NVQ assessor and verifier with ten years experience in this role. The registered manager and the management team are continuing to develop the processes at the home to comply with good practice, standards and regulations. When changes are made to daily routines etc., the service users are consulted. St. Annes is one of a group of care homes owned by The Anchor Trust and is supported by appropriate policy and administrative systems. A senior manager visits Care Homes for Older People Page 22 of 26 Evidence: the home to provide independent monthly reports on the conduct of the home. Quality assurance and quality monitoring systems are implemented. The homes policies and procedures have all recently been updated. Written records are kept of all financial transactions. Service users manage their own finances. The registered providers maintain the health, safety and welfare of service users through implementation of policies and procedures. Records required by legislation are kept. A good rapport exists between management, staff and service users. Supervision of staff is undertaken and appropriately recorded. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 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 25 of 26 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). 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