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Inspection on 24/07/08 for Abbeyfield Rogers House

Also see our care home review for Abbeyfield Rogers House for more information

This is the latest available inspection report for this service, carried out on 24th July 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Although this home was built something like seventeen years ago, it has a number of design features, which would be judged exemplary even by today`s standards. This is a home, which clearly intended to be able to anticipate the changing needs of its elderly service users from start to finish. And it has accomplished this discreetly, without compromising on the quality of furniture and fittings that combine to make this property also very homely. People are genuinely proud to live and work there. This service has significantly more strengths than weaknesses. It provides good evidence of strong and consistent management, delivering good outcomes for people, and uses its resources well. An examination of previous inspection reports will show a sustained track record. Where weaknesses have emerged, the service has recognised them and managed them well. The staff team is competent, well-trained, supported and well deployed. There are clear policies and standards to guide working practice. The systems for assessment, monitoring, reviewing and recording are robust to promote the welfare and safeguard people who use the service. On element which sets this home apart from most others is the level of commitment shown by the large number of volunteers, who come in regularly to enhance the residents` quality of life with support, activities and converstaion. Their level of commitment is commendable. This home is viewed positively by its stakeholders. There are good links with the local community and an open culture.

What has improved since the last inspection?

CARE HOMES FOR OLDER PEOPLE Abbeyfield Rogers House Drewery Drive Rainham Gillingham Kent ME8 0NX Lead Inspector Jenny McGookin Unannounced Inspection 09:30 24 & 31st July 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield Rogers House Address Drewery Drive Rainham Gillingham Kent ME8 0NX 01634 262266 01634 261374 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Abbeyfield Kent Society Lucy Josephine Dixon Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 43. Date of last inspection 25th July 2007 Brief Description of the Service: Rogers House is a modern purpose built home for the care of the elderly; it located in a residential area within easy walking distance of local shops. The home is currently registered for the care of 41 older people. Accommodation is in 37 single and two shared bedrooms, all of which have en-suite facilities or a dedicated toilet close to the room. All bedrooms are fitted with a call bell system and a telephone and TV point. There are 5 day-rooms and a large conservatory opposite the main entrance. The home has 5 assisted bathrooms, assisted toilets and has an 8-person lift providing access to all 3 floors. The current fees for the home range from £459 (Local Authority funded) to £490 (privately funded) per week. Additional charges may be made for additional or specialist care, clothing, outings and entertainment, and personal or luxury items such as hairdressing, chiropody, toiletries and newspapers. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. The e-mail address for this home is: rogers@abbeyfieldkent.org Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This report is based on two site visits, the first of which was unannounced and the second (the following week) was by prior arrangement. These site visits were used to inform this year’s key inspection process; to check progress with matters raised from the last inspection (July 2007); and to review findings on the day-to day running of the home. The inspection process took eleven and a half hours, spread over the two days. It involved meetings with two groups of three service users over lunch, and one other individually, and two visiting relatives. It also involved meetings with a number of individuals representing a range of functions of the home the Manager; a senior carer; the home’s secretary (who also organises staffing rotas); an assistant domestic; two volunteers and a volunteer spiritual adviser. We took a selection of feedback questionnaires with us for distribution to residents, relatives and visiting professionals. Feedback was obtained from four residents and three staff, in time for the issue of this report. Any others will be used to inform the Commission’s intelligence in due course. Consideration was given to the Annual Quality Assurance Assessment submitted by the manager in April 2008, ahead of its due date. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The inspection also involved an examination of records, and the selection of two residents’ case files, to track their care. Personnel files were examined, and interactions between the staff and residents were observed throughout the day. Four bedrooms, selected at random, were checked for compliance with the National Minimum Standards on this occasion, along with some communal areas. What the service does well: Although this home was built something like seventeen years ago, it has a number of design features, which would be judged exemplary even by today’s standards. This is a home, which clearly intended to be able to anticipate the changing needs of its elderly service users from start to finish. And it has accomplished this discreetly, without compromising on the quality of furniture Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 6 and fittings that combine to make this property also very homely. People are genuinely proud to live and work there. This service has significantly more strengths than weaknesses. It provides good evidence of strong and consistent management, delivering good outcomes for people, and uses its resources well. An examination of previous inspection reports will show a sustained track record. Where weaknesses have emerged, the service has recognised them and managed them well. The staff team is competent, well-trained, supported and well deployed. There are clear policies and standards to guide working practice. The systems for assessment, monitoring, reviewing and recording are robust to promote the welfare and safeguard people who use the service. On element which sets this home apart from most others is the level of commitment shown by the large number of volunteers, who come in regularly to enhance the residents’ quality of life with support, activities and converstaion. Their level of commitment is commendable. This home is viewed positively by its stakeholders. There are good links with the local community and an open culture. What has improved since the last inspection? The home’s AQAA told us about a number of improvements since the last inspection, as a result of listening to people who use the service. And the manager gave us even more examples. There is better information and communication: • The information packs sent out to prospective residents have been reviewed and improved. • The residents each have large print activities calendars in their rooms. • There is a suggestion box in the dining room • There is a new complaints booklet, to facilitate its use. There have been improvements to the facilities and services it offers: • The home has completed work on the creation of a consultation room for GPs and district nurses. • It has secured the services of an optician who visits the home and gives training to staff on visual impairment. • There are new procedures for looking after glasses and hearing aids while residents use the hairdresser. • The home has a revised key worker system and residents have been given photographs of their allocated key workers. • There have been more activities, and outside agencies have been involved in this. More use is being made of the home’s garden. There have been improvements to the building and site: • One area on the first floor (formerly a pantry) has been gutted and revamped as a kitchenette facility – it has new units, a water heater has been installed, and there are new implements. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 7 • Two lounges have been redecorated and have new carpets. One has new furniture and the other will be having new furniture in the next four weeks. • All the corridors have been redecorated, and the ground floor carpet has been extended into the corridors to match the reception area. • There is new garden furniture and new activities in the garden. • As people leave, the bedrooms are redecorated and provided with new ensuite furniture. There have been improvements to the staffing arrangements: • Senior carers have time set aside specifically to update and review care plans and other documentation. • Staff have had training on nutrition and fluid intake; tissue viability, osteoporosis, Parkinson’s. • Abbeyfield Rogers has been working with a local hospice to what is known as “Gold Standard Framework” standards, and one member of staff at a local hospice has been given a year’s contract to work with this home and others. • The home has been working with a District Nurse for one resident with terminal illness • One member of staff will be having stroke training • Staff are being actively encouraged to undertake NVQ training, and there is comprehensive staff induction training. • Staffing arrangements are subject to spot checks. • Staff supervision arrangements have been improved. And the home has been developing its business planning skills, to ensure it can demonstrate its commitment to continuous improvement, efficiency and person-centred outcomes. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5, 6 Prospective residents and their representatives benefit by having access to the information needed to decide whether this home would meet their needs. Prospective residents can feel confidant that their needs will be properly assessed and that they will be supplied with a contract, which clearly tells residents about the service they will receive. This home does not provide intermediate care. EVIDENCE: “We came and looked and thought it was wonderful… We never thought she’d come in but it’s the best thing she’s ever done. We should have done this years ago”. Relative Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 11 “We looked at other homes and this came up trumps” - Relative. There is an Information pack for prospective residents, which contains a Service User Guide and a range of loose-leaf documents, usefully describing a range of facilities, services and service principles. Since the last inspection the range of documents has been increased, so as to cover all the elements of this standard. This should ensure that prospective residents or their representatives could be confident they have all the information they need to reflect on, in order to make an informed decision We were told that this pack now also a contents sheet to help the reader navigate through the documentation, and to act as a checklist to ensure all the intended contents were present. This is judged good practice. We were also advised that the home now has an admission checklist, which includes the issue of the Information pack and the question of whether other languages or formats were warranted. This is judged diligent practice, as it would compensate for residents not being able to recall having received this information with any accuracy. As was the case at the last inspection, when asked, residents said that the decision to apply to this home was in practice influenced more by its locality (i.e. close to where they or their relatives lived), and by the home’s reputation, than by any public information produced by the home itself. We found good evidence of preadmission assessments, which routinely take any assessments carried out by funding authorities into account. And feedback confirmed that prospective residents (where able) or their representative could visit the home before the admission, to meet the staff and other residents. A trial stay of one month is available. All the residents spoken to said they were very happy with the choice of home. On their admission, the home carries out further assessments and risk assessments. The home can demonstrate its capacity to meet the needs of residents. See section on “Environment”; the section on “Health and Personal Care” for a description of services provision; and the section on staffing for information on deployment and training. This home provides respite care but it does not provide intermediate care. Should the home provide rehabilitation and/or convalescence, all the elements of National Minimum Standard 6 will apply. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10, 11 Residents can be confident that the health and personal care, which they receive, is based on their assessed individual needs. Residents can be confident that the principles of respect, dignity and privacy are put into practice. EVIDENCE: “As a family the relief that mum is here, well fed, well cared for and well dressed! I can’t fault it in any way … she is blissfully happy here” – relative “She is happy here. Occasionally she says she doesn’t like it. Before she became mentally confused she used to say her how lucky she was to live here” - relative. “The staff are very caring and were wonderful towards **** in her last few days / weeks. She knew she was dying. They would take time out to give her Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 13 a cuddle. I notice the physical contact and people are called by their names. Their names are used all the time. It must be devastating to lose your station in life, mustn’t it. They do little things like painting their nails. Some look so glamorous!” - volunteer Two residents’ files were selected for case tracking on this occasion, to represent the latest admissions (i.e. over the past year). The format of the care plans used by this home properly identify a range of health and personal care needs in the first instance, and these are supplemented by daily reports, assessments (including risks) and records of contact with healthcare professionals. This home has a key-worker system to ensure a meaningful rapport can be built up with residents, and we were told that since the last inspection each resident has been given a photograph of their key worker. And we were advised that senior staff are given one day each month to ensure the records are all up to date. The home relies heavily on its rapport with service users and their relatives to review the care plans – there are no formal multi-disciplinary reviews except those led by funding authorities. Only one or two residents showed any recognition of the process, though their relatives were better able to. Residents did recall being asked questions about their care initially, and on a day-to-day basis thereon, and did confirm that they are generally very appreciative of the level of care given. Records confirm they have access to a range of medical services, according to need. Since the last inspection, the home has completed work on a consultation room for use by GPs and district nurses. But with two exceptions, all the bedrooms in this home are single occupancy, which means health and personal care could in most cases be given in privacy. Unless subject to a GP referral, residents would need to pay for chiropody, podiatry, physiotherapy, specialist, additional treatment or medication themselves. We were told that staff have a range of relevant training – tissue viability, pressure area care, osteoporosis, Parkinson’s, nutrition, and falls prevention. We were particularly interested to hear about the work being done with a local hospice and district nurse for people with terminal conditions. The home aspires to “Gold Standard” framework standards for its care of the terminally ill. And we were also told that the home had secured the services of an optician, who was not only happy to carry out domiciliary visits to the home, but who had also provided training for staff in visual impairment – so that everyone benefits. Staff confirmed that they are regularly receiving training in ‘Just Add Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 14 Water’ and are reminded to encourage residents to drink regularly to pre-empt urinary tract infections. This is recorded on their training matrix. Training in person-centred care planning is being planned to ensure a holistic approach, and we were told that one member of staff will be having stroke management training. This is judged commendable practice. The home uses the Monitored Dosage System of medication, over a 4-week cycle. The home has its own policy on medication, but also has ready access to the Royal Pharmaceutical Society Guidance on medication and directories on drugs, for reference. There were no gaps of anomalies in the medication administration records seen on this occasion. Staff are trained to administer medication, and subject to competency testing. The home’s Medication trolleys are kept properly secured when not in use. Feedback indicated that the daily routines are generally as flexible as healthcare needs and staffing levels will allow. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents are able to exercise choices over their daily life style, and social activities and can keep in contact with family and friends. Residents can be confident that the social, cultural and recreational activities offered by the home will meet their expectations. Residents can be confident that they will receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: “We were told, this is her home, treat it as her home” – relative. “I love the fact there are smaller lounges – not one big lounge with the TV left on. In these lounges you will see people chatting” - volunteer. As was the case at the last inspection, residents were not individually able to give many examples of any particular interests or hobbies being actively promoted by the home, but the home has a lively activities programme, issued Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 16 monthly, and displayed in large print on A3 sheets in communal areas and in each bedroom (showing events every morning and afternoon / evening) based initially on individual assessments, and the home’s administrative assistant also works as their activities co-ordinator. We were particularly impressed to see the large number of volunteers involved with this home and had the opportunity of meeting with three of them. There are in excess of 40 volunteers who come in regularly to run or assist with activities like singsongs, the shop trolley and quizzes, and to chat to the residents. Examples of activities include: Bingo, sing-alongs, arts and crafts sessions (supported by a team of volunteers), quiz and card games, films and slide shows, games and exercises to music. There are hairdressing sessions, manicure and cosmetic sessions. Seasonal events are celebrated, such as Palm Sunday, April Fools Day, Easter, Strawberry Teas, harvest festivals and Christmas. Events in other faiths and cultures are also celebrated such as Raksha Bandan (Hindu). Hawaiian dancing, and a cowboy event was planned! Shopping events are brought on site (e.g. clothing, Body Shop products) and there are periodic outings to a local shopping or garden centre. And since the last inspection residents have enjoyed on-site presentations (including exhibits) by a local museum, and boat trips. During this site visit a local dogtraining group put on a presentation of tricks and obedience. Off site activities include strolls in a local park, outings (e.g. to The Strand, Riverside Country Park), boat trips on the Medway, pub lunches, and shopping trips. The home has its own stock of DVDs, videos etc and there are entertainers. The home has a Loop system in one of its lounges, for use with hearing aids. Religious preferences are properly identified as part of the initial assessment and care planning process. There are services on site and at St Matthew’s Church, which is sited at the front end of the Abbeyfield Rogers site, and there is a Chaplaincy service readily available to residents. In each case, individual and group services can be arranged. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. They were observed being supported to make choices and decisions during the day of this inspection. One lady comes in to lead Motivation sessions to try to encourage residents to build up their confidence to try things. Residents are able to have visitors at any reasonable time. The home is reasonably well placed for links with the local community (see also section on “Environment”). All the bedrooms have telephone points. Residents can have Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 17 lines installed in their own bedrooms, at their own expense. Unless other arrangements have been made, residents receive their mail unopened. Catering needs are properly identified as part of the preadmission process and updated or amended thereon. There is a five-week cycle of menus. This is traditionally drawn up by the cook in consultation with staff giving direct care, and alternatives are always available. We were told that the home uses local sources of fresh produce. Records are maintained of the options chosen by individuals, as required, and special provision is made for individual preferences, and residents with swallowing problems e.g. early-stage dementia. When asked, the cook said she hadn’t had specialist training for the elderly or dementia (this is strongly recommended), but had received instruction from a catering manager from head office and had read relevant articles. The inspector joined residents for lunch on both visits and judged the meals well prepared and well presented. The residents confirmed this was representative, and that alternatives were readily available. The pace was unhurried and congenial. The dining area provides pleasant settings but residents can choose to eat elsewhere. One recess in a first floor balcony has been a popular spot for breakfasts and snacks in the good weather. We were particularly interested to hear that Abbeyfield Rogers is planning a restaurant evening - a chef will be brought in and there will be have waiters attending the tables etc. This is judged an inclusive approach – designed to enable those residents who can’t or won’t go out for a meal to enjoy a restaurant atmosphere. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 16, 17, 18 Residents can be confident that their complaint will be addressed properly since they have access to a robust and effective complaints procedure. Residents can feel confident that they are protected from abuse and will have their legal rights protected. EVIDENCE: This home has a clear complaints procedure, which is in a booklet included in the Information Pack given to prospective residents and it is also available on request. The last inspection recommended that the home’s complaints procedure be amended to take account of the new inter-agency arrangements, once they became publicised. This matter was still outstanding. The home keeps a register of complaints, as required, and access to its contents is restricted to those properly authorised. This is subject to quarterly audits and findings are included in Abbeyfield’s own unannounced monthly inspections, so that the company is always aware of emerging issues. The range of complaints registered was judged a realistic reflection of communal living, and there was good evidence of the home’s responses. Residents and their representatives can have confidence that the home’s culture is to take concerns and complaints seriously. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 19 The home has information on independent advocacy services on display but families and friends tend in practice to be relied on to provide this. We were told that since the last inspection staff have all had training in the new mental capacity legislation, to ensure rights are properly promoted. The home has procedures to ensure that service users are safeguarded from abuse in all its forms, including police and criminal record checks on prospective staff - and staff confirmed their commitment to challenge and report any incidences of abuse, should they occur. In the event, this has not been warranted. We can confirm that no complaints or adult protection proceedings have been raised against the home since the last inspection (July 2007). Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 19, 20, 21, 23, 24, 25, 26 Residents benefit from living in a home in which the physical design and layout have been well thought through and it provides residents with a safe, wellmaintained and comfortable environment, which encourages independence. EVIDENCE: This home is in Wigmore, close to Rainham and Gillingham, with all the community and transport links that implies. There are local shops and a library, and a larger shopping precinct with a superstore a short distance away. The nearest train station is Rainham, and there is a bus route, which stops at the end of Drewery Drive. On-site car parking facilities are good (up to seven vehicles at a time), and there is unrestricted kerb-side parking along Drewery Drive. Measures are in place to keep the premises secure against Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 21 unauthorised access, including CCTV and a call system, without infringing on the residents’ freedom of movement. The layout of this home is judged generally very suitable for its stated purpose; it is accessible, safe and well-maintained. Comfortable temperatures and lighting levels were being maintained throughout. The residents have a good choice of communal areas (which includes five lounges), and they are each spacious. The furniture tends to be domestic in style and of good quality, and there were homely touches everywhere. Since the last inspection, several areas have benefited from re-carpeting and/or refurbishment, with more in prospect. One area on the first floor (formerly a pantry) has been gutted and revamped as a kitchenette facility – it has new units, a water heater has been installed, and there are new implements. Two lounges have been redecorated and have new carpets. One has new furniture and the other will be having new furniture in the next four weeks. All the corridors have been redecorated, and the ground floor carpet has been extended into the corridors to match the reception area. There is new garden furniture and new activities in the garden. As people leave, the bedrooms are redecorated and provided with new en-suite furniture. All corridors and doorways are wide enough to allow the passage of wheelchairs and mobility aids; and there is a spacious shaft lift and staircases to access all floors, so that residents can move about as independently as possible. All areas are linked with a call bell system. Specialist provision is in place but it is not overly conspicuous and includes hand and grab rails, raised toilet seats, push and lever operated door handles, doors which can be lifted off their hinges in an emergency, and lifting equipment, including hoists. This list is not exhaustive. The home was clearly designed to maintain its capacity to meet the emerging needs of its residents and best practice standards. It’s designer is to be commended. This home is currently registered to provide care for up to forty-three residents, and although two bedrooms are registered as double rooms, all are currently being used for single occupancy. Two bedrooms on the top floor have exclusive use of bathrooms directly opposite their doors, but all the rest have their own en-suite facilities. So that residents can be assured of privacy. Four bedrooms, selected at random, were inspected on this occasion, and judged well maintained and personalised. In terms of their furniture and fittings, moreover, they showed a generally sound level of compliance with all the provisions of the National Minimum Standards, though they didn’t all have a second comfortable chair – the manager was advised that non-provision Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 22 must be justified by a properly documented risk assessment or consultation. When asked, in fact, one resident said she would like to have a second chair. All the bedrooms have telephone points, and television points - and all are linked to a call system facility. And there are five communal bathrooms (with assisted or Parker baths) and seven communal WCs i.e. all reasonably close to bedrooms and communal areas. All the maintenance records seen were up to date and systematically arranged. Since the last inspection, the home has had a new comprehensive fire panel installed, top keep people safe. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 The care of residents is enhanced because staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of residents. EVIDENCE: This home’s staffing arrangements are designed to ensure that (excluding the manager) there are always at least five care staff on duty, plus a senior, during the mornings and four care staff, plus a senior during the afternoons. There are additional staff to cover peak periods (8-11am and at afternoon tea time). At night there are always two waking staff from 9.30pm till 7.30am, with two staff on call. The home has ready access to a bank of flexi staff to cover peak periods. In the absence of the manager there is always someone in charge, with an oncall system as a back up – and we were advised that unannounced spot checks are carried out to keep people safe. Team working continues to be identified as a key strength. Staffing rotas were submitted to the Commission to confirm this arrangement, and there have been no concerns raised with the Commission about the home’s capacity to maintain these staffing levels. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 24 An examination of three personnel records, selected at random, confirmed feedback from staff, that this home has a systematic recruitment process to comply with the key elements of the standard. Records also confirmed that volunteers are subject to the same process and checks – this is judged robust practice, designed to keep people safe. New staff are subject to a comprehensive induction within six weeks of starting work at the home. Staff and records confirmed that there is a sound level of investment in mandatory training (e.g. moving and handling, medication, food hygiene, First Aid and Health and Safety, COSHH and infection control) to keep the service users safe. We were particularly impressed to hear about the other training investments being made – fluid intake, nutrition, tissue viability / pressure area care, falls prevention and visual impairment – all of which are likely to enhance the standards of care given. Comments from residents and their relatives showed they were very appreciative. Some specialist training such as dementia care was identified as a further training need, so as to anticipate the emerging needs of one or two residents. We were told that all staff are required to undertake NVQ training upon the successful completion of their probation period. The AQAA told us that 19 of the 29 staff have NVQ accreditation, and we were told there were two more in prospect. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 34, 35, 36, 37, 38 The home is run for the benefit of residents in that the management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: “It’s a lovely place to be – the people and its position. You can sit at the back for lunch. It’s quite jolly. There is always someone to talk to” – staff member Of the manager “Even when she’s not here, she’s on the ball…I think everyone would say she’s made a good effort. You can go and talk to Lucy or Lorraine about anything, day or night. The residents are friendly” – staff member Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 26 “I think its very, very human. I’ve been working in care a very long time where it was all so restrictive. Here, it’s human, down to earth. The managers are very down to earth and we laugh an awful lot. It’s the happiest I have been. You can feel it from the clients and staff. We give them anything they want. We don’t believe in the word “no”” – staff member “I’d have to go a long way to find anything that needs improving. We are trying to get carers to write more detail for particular clients. The first thing that struck me was eh way they are treated here – it was the way they wanted to be treated”. The Commission’s registration process has established that the manager has the relevant training (including the Registered Managers’ Award and 1st level nursing qualification) and experience for her role, and this is supplemented by updates. There are clear lines of accountability within the home and the Abbeyfield organisation; and staff and residents have reported that in-house line management is invariably accessible and supportive. There was good evidence the National Minimum Standard being exceeded in terms of the frequency of formal, documented staff supervision sessions (in many cases at least monthly), though periodic appraisals were less evident. Abbeyfield has been generally able to evidence compliance with its duty to carry out formal documented inspection visits at least once a month (Regulation 26) though there were a significant gap (five months between March and July 2007) when the relevant delegated officer left the organisation. This shortfall is effectively holding the home back from an otherwise “excellent” quality rating for this standard. All the current residents are white British. Three are male – the rest are female. All the staff are currently female because this is what residents have reportedly said they wanted. And the staff group shows slightly more ethnic diversity – one is from the Philippines, two from Africa and one is Italian. All the rest are white British. Records confirm there are periodic group meetings with the residents and their relatives to discuss the running of the home, and the home has a suggestion box so that comments can be submitted anonymously. There have also been quality assurance initiatives (including questionnaires) every year as well as a range of auditing exercises, to evaluate the home’s performance against its stated aims and objectives. Abbeyfield has formal annual business planning processes, which the home contributes to with projects. The home makes provision for the proper storage and accounting of personal effects and small sums of pocket money. Each bedroom has a lockable facility. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 27 The home’s property maintenance certificates seen were up to date and systematically arranged to facilitate access. There are daily health and safety inspections around the home, to keep people safe. Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 4 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X X 4 X 4 Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 30 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should clearly single out one resident’s needs from another’s. And they should more actively: evidence the active participation of interested parties, most notably the residents pursue the residents’ emotional needs offer specialist interventions e.g. to the individual with dementia establish any unmet needs. These elements should be attended to ensure a more holistic approach. The home’s complaints procedure will require amendment to take account of the new inter-agency arrangements, once they become publicised 2 OP16 Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Abbeyfield Rogers House DS0000028736.V367000.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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