Care Home: St Anthonys Care Home

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What the care home does well St Anthonys provides personal care and support for a maximum of 16 people. On the day of the inspection residents looked well cared for and those spoken to said they were happy living in the home. Staff were observed working with people in a positive manner which generally resulted in individualised care and support. The staff seemed to work well as a team. Pre admission assessments are always carried out to ensure that the home can manage the needs of the person. Ongoing training means that staff are up to date and have the skills to look after the residents. Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time and each afternoon a carer is allocated to do `activities` either in a group or on an individual basis. Entertainers are bought into the home at least once a month and the variety of communal space means that people can spend time where and with whom they like. People spoken to said that they like the new `garden` room and enjoy the views of the garden. What has improved since the last inspection? The new `garden` room has been completed making more communal sapce available for people to use. Ongoing redecoration and refurbishment means that people have a safe, homely and comfortable home to live in. What the care home could do better: Cold drinks for lunchtime should not be poured out and put on the dining room table over an hour before the meal as they may become contaminated and warm. It could also mean that people are not getting a choice of different drinks as it is assumed they will have the same thing each day. The assistant manger and provider were told of this observation on the day of the insepction and said it would not happen in the future. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Anthonys Care Home St Anthonys Station Road Liskeard Cornwall PL14 4BY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 25 Information about the care home Name of care home: Address: St Anthonys Care Home Station Road St Anthonys Liskeard Cornwall PL14 4BY 01579342308 01579348549 stanthonycare@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Anthonys Limited care home 16 Number of places (if applicable): Under 65 Over 65 5 16 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 St.Anthonys is a care home providing accommodation and personal care for up to 16 older persons. It is situated near the centre of Liskeard and the local amenities include shops, health centres and railway station. Bedrooms are provided on both the ground and first floors, with a stair lift to assist service users. Communal areas are provided for service users on the ground floor and include a lounge and dining room. There is a large private garden at the rear and car parking at the front of the home. An extension to the building is now complete providing four extra bedrooms all of which are ensuite. Further improvements are planned. Care Homes for Older People Page 4 of 25 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: two star good 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 Key Inspection took place from 10.10 am until 2.45pm on 4th June 2009. It was conducted with one of the providers and the assistant manager. A tour of the home was carried out and residents and staff were observed and spoken to informally during this time. A variety of records were seen during the course of the day. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission) and completed surveys from both care staff and residents was also used to help form the judgements made in the report. Care Homes for Older People Page 5 of 25 Care Homes for Older People Page 6 of 25 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 set out 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 7 of 25 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 8 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home Evidence: The provider and assistant manager said that people are always assessed prior to moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible, invited to look around (without making an appointment) and spend some time at the home and ask any questions they may have. The AQAA told us that we produce a fairly professional computerised Statement of Purpose (SoP) complete with photographs which is usually produced for each individual prospective resident or Care Homes for Older People Page 9 of 25 Evidence: their family. This gives us the chance to incorporate any changes that have been made recently. The current fee level ranges from £314 to £406.60 per week (correct June 2009). If people decide to stay at St Anthonys the contract describes their rights and responsibilities, what the fees are and what is included in the fee. Care Homes for Older People Page 10 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be met. Evidence: The assistant manager said that all of the care plans are updated daily and reviewed monthly. The care staff complete daily records about a persons welfare and detail what care has been provided. The 3 care plans examined set out peoples needs and contained information about visits made by or to health care professionals such as GPs, district nurses, opticians and dentists. Individual risk assessments seen were up to date and relevant. A tour of the home showed that equipment to help skin stay in a good condition and for prevention of pressure sores is available and meets peoples current needs. The assistant manager said that they have enough equipment and most specialist equipment is provided by the community nursing services as required. The home uses a blister pack system for administration of medicines. They are stored in a locked trolley, which was clean and well organised. The drugs fridge has its Care Homes for Older People Page 11 of 25 Evidence: temperature taken and recorded daily. The records of administration were clear and a photograph of each resident is kept with the record to aid identification. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. Care Homes for Older People Page 12 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: People are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups for an hour each afternoon. The provider said that an entertainer comes into the home at least once a month. The care plans are designed so that information about peoples interests and hobbies is recorded and can be used when trying to develop person centred care. One person told us that they like to stay in their room but do mix with others when they want to. The AQAA states that we are to send one of our staff on a Creativity in a Care Setting course run by Arts for Health in Cornwall (Truro). The provider said he is hoping this will help staff to think of new ideas to keep the residents occupied. Visitors are welcomed at anytime and people were seen coming an going freely during the inspection. There is a mature garden to the rear of the house which is accessible to the residents. It was clear that Care Homes for Older People Page 13 of 25 Evidence: the residents like the prescence of the providers dog in the home. Most people have their meals in the dining room, the provider pointed out that the tables are down the centre of the room and that people seem to like it that way and choose to sit near like minded people with whom they can chat. There is a 6 weekly menu rota, people are asked what they would like for their meal and there is always a choice. Drinks and snacks are available 24 hours a day. The assistant manager and provider were reminded that care staff should not pour out lunchtime drinks over an hour before the meal was to be eaten, the drink would be warm and may have been contaminated with dust for example. Although the assistant manager said people had choice over what drink they wanted the fact that they were put out prior to the meal indicates that staff assume what they would like to drink and they may have the same thing everyday. Records are kept of what people eat to ensure they are receiving a balanced diet. A number of people who live at the home are diabetic and the assistant manager said that the care and catering staff know about diabetic diets and healthy eating. The assistant manager said that staff are available at mealtimes to give people any help or support they may need. Care Homes for Older People Page 14 of 25 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Some staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the Statement of Purpose. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission in the last 12 months and the AQAA states that the home received 1 complaint which was upheld. The assistant manager said that people are seen by senior staff daily and hopes that any issues or concerns would be bought up at then. The provider said that they have regular contact with a number of relatives and feels they would be able to approach them with any concerns that would then be dealt with quickly. One of the four completed resident surveys indicted they did not know how to make a formal complaint the rest all said they did. Records show that some staff have attended safeguarding training, they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. Care Homes for Older People Page 15 of 25 Care Homes for Older People Page 16 of 25 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. Ongoing refurbishment, redecoration and maintenance means that people have a comfortable, homely and safe environment in which to live. Evidence: The home is close to public transport, local shops and facilities of Liskeard. The detached building offers bedroom accommodation on the ground and first floors, with all communal areas being on the ground floor. On the day of the inspection 15 people were resident at the home. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. People spoken to said they were happy with their current accommodation. The stair and landing carpet are worn and will need replacing in the near future.The providers have an ongoing programme of routine maintenance and redecoration. Communal space consists of a lounge leading onto a new garden room (completed since the last key inspection) and a dining room. People spoken to in the garden room said they enjoyed the views of the garden and liked the big windows. The garden, mostly laid to lawn, is well maintained and accessible to residents. Car parking is available at the front of the house. The home complies with the local fire service and environmental health department requirements. Care Homes for Older People Page 17 of 25 Evidence: There are currently enough assisted bathrooms, shower rooms and toilets for the people who currently live at the home and many rooms have en-suite facilities. People access the first floor via a stair-lift. On the day of the inspection the home was clean, tidy and hygienic. There is a cleaner employed for 2 days a week and the care staff do the cleaning the rest of the time. A carpet cleaning company are used regularly to deep clean all the carpets, they do a few at a time and were doing some on the day of the inspection. The assistant manager said that the night staff do the laundry. All four completed residents surveys indicated that the home is always fresh and clean. Policies and procedures around infection control are up to date and available to staff at all times. In house training on the importance of infection control is routinely offered to staff. Care Homes for Older People Page 18 of 25 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. The staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: On the day of the inspection there were appropriate staff numbers and skills mix available to provide the required care and support for people. Three carers are on duty in the morning and this is reduced to two in the afternoon. A cook (daily) and domestic staff (twice a week) support the carers. At night there is one waking member of staff and one asleep but on call. The providers live on the premises and provide administrative support, overnight on call and also provide some care and support. All three of the completed staff surveys indicated that there are always enough staff to meet he individual needs of the residents. There is a stable staff group and a variety of training opportunities are provided including first aid, moving and handling and food hygiene. The AQAA states that 7 of the 13 care staff have completed at least an NVQ level 2 in care. Upcoming training dates were seen displayed on the staff notice board. Staff files we looked at all had completed application forms, 2 written references, Care Homes for Older People Page 19 of 25 Evidence: CRB/POVA clearances, statements of terms and conditions of employment and job descriptions. The AQAA states that ten staff have completed an induction process and all three completed staff surveys indicated that their induction covered everything they needed to know to do the job when they started very well. Care Homes for Older People Page 20 of 25 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. The systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The registered manager/provider is appropriately experienced having worked in care for many years. The registered persons were able to demonstrate that they have appropriate checks in place for various health and safety procedures including portable appliance tests, insurances, environmental health and the maintenance of fire safety. Although the providers should ensure that when the fire alarm is tested in their absence the test must be recorded in the appropriate place. The registered persons conduct regular quality assurance surveys using satisfaction Care Homes for Older People Page 21 of 25 Evidence: surveys. The results of these surveys are analysed and evidence that action is taken to improve the service is available. A number of thank you cards and letters were seen during the inspection. The assistant manager said that the decision whether to have a bath or shower in the extension (completed within the last 2 years) was discussed with the residents and the decision was based on what they said. The homes policies and procedures are up to date and available to staff at all times. We saw the written records kept of all financial transactions on behalf of the residents, they included income and outgoings and receipts . Secure facilities are used for storage of money and any valuables. The registered providers maintain the health, safety and welfare of the residents through implementation of their policies and procedures. Appropriate records were seen to demonstrate this. The provider carries out ongoing routine house and garden maintenance. There appeared to be a good rapport between management, staff and residents. Supervision of staff is undertaken and appropriately recorded. Records of some supervision sessions were seen in staff files examined. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 15 Cold drinks for lunchtime should not be poured out and put on the table over an hour before a meal. People should be given a choice at the meal table when the drink will be fresh, at the correct temperature and it is clear people are being given a choice. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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