Inspection on 03/02/10 for Abbeymere Care Centre

This is the latest available inspection report for this service, carried out on 3rd February 2010.

CQC found this care home to be providing an Good 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.

Other inspections for this house

Abbeymere Care Centre 21/02/08

Abbeymere Care Centre 21/08/07

Abbeymere Care Centre 20/03/07

Abbeymere Care Centre 04/01/06

Abbeymere Care Centre 22/09/05

Abbeymere Care Centre 24/03/05

Abbeymere Care Centre 18/05/04

Abbeymere Care Centre 08/07/03

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Abbeymere Care Centre 12 Eggington Road Stourbridge West Midlands DY8 4QJ     The quality rating for this care home is:   two star good 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: Monica Heaselgrave     Date: 0 3 0 2 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 33 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 33 Information about the care home Name of care home: Address: Abbeymere Care Centre 12 Eggington Road Stourbridge West Midlands DY8 4QJ 01384395195 F/P01384395195 abbeymere@abbeycare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Karelink Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 18, Physical disability (PD) 18 Date of last inspection Brief description of the care home Abbeymere Care Centre is registered for the care of 12 older people and 6 people with physical disabilities over the age of 65. The Home aims to enable people from a multicultural society and diverse community to continue living as independently as possible by receiving care and support consistent with their incapacities and disabilities. Abbeymere is a converted and extended residential property and is Care Homes for Older People Page 4 of 33 Over 65 18 0 0 18 1 1 0 3 2 0 0 9 Brief description of the care home located in Wollaston, within a short walking distance of the village, this having a variety of amenities and facilities. The house is on a main bus route giving access to neighbouring towns. The building comprises of a large communal lounge, dining room and a number of bedrooms (as well as kitchen, laundry, bathroom and toilets) on the ground floor and bedrooms, bathrooms and toilets on the first floor. The home has a shaft lift and some other aids and adaptations consistent with the needs of older people. There is some car parking space to the rear of the building. The staffing in the home consists of a acting manager who is supported by senior care and care staff as well as ancillary members of staff. A director of the company is responsible for line management support to the acting manager. Information regarding fee levels can be obtained from the homes Statement of Purpose. However for up to date range of fees people are advised to enquire at the home. Fees paid do not include extra services such as private chiropody and hairdressing. A Statement Of Purpose and Service User Guide is available to inform people of their entitlements including how to access a copy of the inspection report. Care Homes for Older People Page 5 of 33 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: We carried out an unannounced visit to the home which means that the provider did not know that we were coming. The visit was undertaken to establish if the service is run to the best interest of those who live there and offers a good quality and safe Service. Prior to the visit we looked at a variety of information. This included things the Service must tell us about such as any accidents or concerns that have taken place. We also looked at the Annual Quality Assurance Assessment that was completed by the manager. This provides up to date information as to how the Service is run and the improvements the Service wishes to make. During our visit we tracked the care for three individuals looking at all the documentation in respect of their care. We observed practice and talked to the people who live there as well as the staff and acting manager. We reviewed a range of other documentation as well as looking around the building. We identified concerns in relation to pressure care relief and the monitoring of nutritional supplements. As a result of these concerns the proprietor was required to review the practice in relation to pressure care relief and the monitoring of nutritional Care Homes for Older People Page 6 of 33 supplements. We received a response from the proprietor confirming that recording and monitoring in these areas has been improved so that it is more robust. We will continue to monitor this aspect to ensure standards are maintained. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Immediate concerns are dentified in relation the recording and monitoring of risks. Poor record keeping could mean people do not get regular pressure relief or receive nutritional supplements. We cannot be sure that these needs are well managed. The home was required to make some immediate improvements to improve their practice and prevent further health complications. We received confirmation from the owner that new systems have been put into place to address these concerns and improve the outcome for people. These improvements must now be sustained. Care plans could be further developed so that they say exactly what people need and Care Homes for Older People Page 8 of 33 want making them more personal. These should also reflect how health risks are managed following advice from health care professionals. This is to ensure the health care support people need is up to date and continuity of support is evident. There is a need to improve communication. More frequent staff meetings would enable the staff team to develop their understanding of the care practice and develop a consistent approach and skills base. Training in pressure relief would equip staff with the skills necessary for meeting these needs and to fully understand the importance of doing so. The provider needs to secure the application for the registration of the acting manager. For the effective management of the home the acting manager should complete the Leadership and Management qualification. 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 9 of 33 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 10 of 33 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 are provided with a variety of information which helps them to make an informed choice about whether or not they want to live at Abbeymere, The arrangements for identifying support needs is good and means they can be properly planned for. Evidence: The process for admission is clear and assures us that any person wishing to use this service has a full assessment of their needs prior to moving in. This is undertaken usually in the persons own home and fully includes them and their family members. Family members spoken with confirmed that they had the opportunity to visit the home prior to making a decision. A second person was admitted for respite care on the day that we visited. Records for this person showed the process to be the same. One relative told us that the admission was good and that the family and the person admitted had been involved. Care Homes for Older People Page 11 of 33 Evidence: They also said that as the needs of their relative had changed they were happy that the home had responded to this speedily and was caring in their approach. Both parties said that they had received information regarding the service provision. This was both verbal and in the form of the homes own brochure. They also received written confirmation that the home could meet their needs. These documents were also seen to be on their files. The Statement Of Purpose is specific to Abbeymere and provides a range of information about the service provided. This included the aims and objectives of the service and details of staffing arrangements. This ensures people know what to expect from the home. The people we spoke to told us they were happy with their experience. Observations made on the day of our visit showed that staff was supportive in settling a person in and making them comfortable. Care Homes for Older People Page 12 of 33 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 personal and health needs of people who use the service are identified but this is not fully evidenced in their care plan. There are some gaps in records and the monitoring of needs is not always robust. Staff would benefit from training in pressure care management to ensure they have the skills to meet these needs. Evidence: We looked at three care plans. The care plans had been drawn up from the pre assessment information which showed staff has information about the needs of people and the support they require. The care plans were not comprehensive and lacked some detail. For instance where they identified the interests of people in the assessment information the care plan did not elaborate to show how these would be addressed. One Life biography and activities profile clearly identifies the interests of the person such as doing word searches watching films and cooking. The care plan repeats this but does not develop it further as to how the person will be supported to do these activities. Each of the care plans had evidence of recent updates. These related to physical and Care Homes for Older People Page 13 of 33 Evidence: health care changes. There was no review of social or emotional needs and how these are met. The updates whilst important do not fully detail what needs to change to ensure the person receives the correct support in this area. Daily records are completed by staff but these are limited in their detail and refer mainly to the physical needs of people. They do not tell us how people are responding to events or activities or the care they receive. In one instance where a lady required her legs to be elevated there was no comment in her daily records to reflect if this was being done. The daily records are an important way for staff to monitor and review the care practice for individuals. Without these records staff are unable to review accurately and this is important when reviewing the care plan and setting new goals. Care plans need to be personalized and provide detail of the action to be taken by staff to support people. Care plans should outline what they can do independently the activities people require assistance with and the actions staff need to provide in order to support them. There was evidence that risk assessments had been completed in respect of pressure care management and nutrition. However the strategies in place to reduce the risks were not followed through into the care plan. The care plan must reflect the steps staff need to take to support the person in this area. For instance where the person is at risk of pressure sores and the risk assessment is completed this must then be reflected in the care plan. The plan must state the response to pressure care management such as what staff must do to manage this what equipment is needed and any routines such as turning pattern or encouraging fluids. Whilst this information is evident it is not translated into preventative actions in the care plan. The format of the care plan could be improved. Currently there are several sections staff complete and update. This makes it difficult to read one complete and up to date plan that is personal to the individual. Staff training in person centred planning is indicated. Two people had their weight monitored. These records indicated that their weight had remained stable. One person was prescribed a nutritional supplement and staff had signed medication charts to indicate that this had been given to the person. However the fluid monitoring chart did not indicate that the person had actually drunk the nutritional drink. The fluid monitoring chart showed the person was receiving a good fluid intake. A pressure relieving mattress was in use for one person who is at risk of pressure sores. The turning chart did not specify the time the person was turned or the side they were turned to. One entry simply stated they had been turned every two hours. Without specific information as to the times of turning and the position turned to staff cannot be sure that the person is receiving regular pressure relief. The health care records for this person did not contain any information relating to Care Homes for Older People Page 14 of 33 Evidence: pressure care. The acting manager was not able to confirm who had implemented the two hourly turning patterns. There was no evidence that care staff had received any training in relation to pressure area care or related issues. The person concerned had been in bed for one day therefore the implications of these practices had not had a detrimental affect on them. However this does raise some concerns about the practices in this area. There is a need to clarify what instruction was given and by whom. This should be clearly recorded in the health care notes to guide the practice of the care staff. Either staff has failed to keep accurate records or is initiating this practice without advice from the district nurse or G.P. This could place the person at risk of further health complications relating to pressure care. As a result of these concerns the proprietor was required to review the practice in relation to pressure care relief and the monitoring of nutritional supplements. We received a response from the proprietor confirming that recording and monitoring in these areas has been improved so that it is more robust. This will ensure that concerns are identified quickly and necessary steps taken to ensure people are not at risk of further health complications. Whilst viewing some of the bedrooms it was noted that bed safety rails were in use. Risk assessments and monitoring records were in place to ensure proper use and continued safety of the rail. The manufacturer instructions were also evident so that staff knows how to use the rails safely. There was evidence of visits by Health and Social Care professionals such as the district nurse and G.P. Staff must ensure that where advice is given by health professionals it is always recorded in the health care notes to ensure this guides staff practice. We saw that there was agreement and consent for the use of a monitor to establish when an individual was getting out of bed at night and at risk of falls. This has been considered necessary to promote the safety of the person. Abbeymere has an appropriate medication procedure. The system in place for administration and storage of medication is safe. The MAR charts showed that a nutritional supplement had been signed for by staff but this did not correlate with the fluid record so we cannot be sure this was actually taken. Staff must ensure that they follow the procedures for the signing of medication as they administer it. This will ensure the documentation of medication is accurate and that there is a clear record to show what the person has actually had. The most recent inspection by the homes contracted pharmacist identified that medication reviews are to take place with the G.P. Care Homes for Older People Page 15 of 33 Evidence: Staff was observed to assist people and they were fairly well supported in respect of personal care and choosing appropriate clothing. Some people told us that their personal preferences in relation to their daily routines were well met. We were informed by people that they had the assistance they needed usually without delay. They described staff as helpful and responsive. People had keys to their bedrooms and access to a phone. We received five questionnaires back from people who live at Abbeymere. Some people had been supported to complete these by their family. Two of these told us that they usually receive the support they needed. Two stated they always received support. One made no comment. Two questionnaires stated staff is always available when they need them. Two stated staff is usually available and one made no comment. Four returned questionnaires stated people always get the medical support they need and the fifth saying this was usually the case. Three of the families commented that they found the care arrangements to be good and staff are always polite and offer help and support. Two of these commented that more staff is needed as staff is very busy. The survey of approximately a third of the people tells us that they are generally satisfied with the care they receive at Abbeymere. Care Homes for Older People Page 16 of 33 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. People who live at Abbeymere continue to enjoy a growing range of stimulating activities. They enjoy meals that are appealing. Friends and families are fully encouraged and welcomed. Evidence: There is a white board which displays activities. This showed a range of activities are on offer. Some of these included trips to the village for shopping and lunch. There are activities that come into the home such as singers and the hairdresser. On the day we visited a visiting pet scheme came for the first time. The dog was clearly enjoyed by the majority of people who interacted with him and his handler. We were told that as this was so successful they would continue with this as a regular activity. There was lots of photographic evidence of events that people had enjoyed and leaflets as to what is available locally. The AQAA tells us there is an activity coordinator. We spoke with her and she confirmed a range of activities has been utilized and they try to arrange interesting events. One of the ladies told us she enjoys the library which was seen to be well stocked. She enjoys the news papers which are delivered daily. Other people told us they enjoy the range of activities and can ask staff to explore things they are Care Homes for Older People Page 17 of 33 Evidence: interested in. A regular visitor to the home enjoys a daily lunch. He told us he enjoys the activities and company. Care plans did not say how people would be supported with activities but pre assessment did identify these. It is evident that a range of activities are on offer although there is no means of evaluating activities to ensure they meet with expectations. The activity coordinator told us she is looking at ways to ensure activities can be linked to individual care plans. People told us they can move freely around the home watch their own T.V. and listen to music. There is a large screen T.V. in the lounge and music was playing earlier. Care staff do gentle light exercise with a few people some of whom told us they enjoyed this. Some people utilize community amenities such as links with a local church luncheon group where a number of individuals go for a meal. They can enjoy games and participate in a service with the opportunity to meet their spiritual needs. Staff also takes people out to the local shops on a planned basis. The menu for the day was displayed and showed that there is a choice of meal. Menus viewed showed meals are varied and nutritious. The menu could be written larger for ease of reading. The meal we saw on the day was consistent with the menu. The days meal was home made chicken pie and vegetables gravy and potatoes with a choice of pudding. Every one we spoke with commented on the good home cooking. A relative told us that cakes are always on offer and that these are of a good quality and home made. People certainly seemed to enjoy the meal which was seen to be plentiful. We saw staff was available to assist people with their meals. Staff asked people after the meal if they had enjoyed it. People told us that they had some favorites such as meatballs and mash and peas which they enjoyed in their youth. It was pleasing to see that menu choices included traditional Black Country options preferred by the people. Food was not removed until individuals had finished with it and staff was knowledgeable as to eating habits. Staff was seen to encourage people to drink throughout the day and this was also reflected in the fluid monitoring records we saw. Care Homes for Older People Page 18 of 33 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. People who live at Abbeymere know how to raise their complaints and concerns and are confident staff will listen and act on them. Staff has had training to improve their understanding of managing and protecting people from abuse. Evidence: People at Abbeymere have access to a complaints procedure. This is provided to them and their families once the placement is agreed. One family spoken with confirmed this to be the case. The procedure is in large print making it easier for people to see. This was displayed on the notice board for easy access. Information about other agencies that people may wish to contact including Advocacy was also seen to be available. We asked people who live at Abbeymere if they had concerns and if they knew how to complain or how to report them. They told us that they had no reservations in voicing their concerns. People told us that staff always enquires if they are well. Our observations showed that staff spend time talking to people and relations appeared very good. Several people are articulate and they as well as regular visitors confirmed that there is confidence in the staff members. At the previous inspection visit it was found that the home had not worked within the framework set out by the local authority for safeguarding people. They had delayed in reporting their concerns and had conducted and concluding the matter prior to a Care Homes for Older People Page 19 of 33 Evidence: multi-agency meeting taking place. It was also found that staff required training so that they are aware of and follow the multi agency safeguarding procedures. Information in the AQAA and staff training files show that staff has undertaken this training facilitated by Dudley Social Services. Discussions with individual staff and the manager show they understand this process and know who to report concerns to. The proprietor demonstrated his knowledge for these procedures. Multi agency guidelines are available in the home to guide all staff in this area. Sampled staff supervision records show that staff has had the opportunity to discuss and develop their understanding of these procedures. However more frequent staff meetings would enable the staff team to explore their practice and learn from each other. This will enable them to develop a consistent approach towards protection matters. At the present time Abbeymere are waiting for the conclusion of a safeguarding investigation by the local authority into their practice. The issues relate to lack of nutritional care and pressure care. This is currently being investigated and is still open. Care Homes for Older People Page 20 of 33 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. Abbeymere presents as a homely and comfortable environment. There has been continued improvement in the facilities and standards ensuring these meet the safety and welfare needs of the people who live there. Evidence: On a tour of the home the home we found that there had been continued improvements. The heating boiler had been replaced and temperatures throughout the home appeared appropriately warm despite the severe freeze outside. The dinning area at the front of the property was furnished with new dining room chairs. During the meals we observed people appeared able to move the chairs easily to sit to the table. However one person leant heavily on the chair for support and it tipped. It is advised where people are a little unsteady on their feet a risk assessment should be in place to identify if this is the correct chair for them. Not everyone sits to the table in the dining room. Some people had their meals in the lounge and it is good they had this option. There is a notice board in the dining room to inform people of the menu choices however the writing could be a little larger to ensure people can see it. The clock in the dining room is very small and possibly hard for people to read. The lounge area is spacious well furnished and decorated. People had their personal Care Homes for Older People Page 21 of 33 Evidence: items and walking aids within easy reach ensuring they can move around independently. The toilet and bathing facilities are well placed and easily accessed. Facilities can be locked which ensures people have their privacy. There is a choice of shower or bath tub and the home has a number of hoists in each area so that staff can assist people safely. All the equipment had up to date service certificates demonstrating it is safe to use. Toilets are raised making it easier for people to use them and there are hand grab rails to support people to mobilize. A random selection of bedrooms was looked at. All of these were clean with towels and toiletries attractively prepared for the people who live there. Bedrooms above ground level had window restrictors to reduce the opening and prevent falls. Radiators were fitted with covers to prevent the risk of surface burns to people. Each bed was appropriately located within reach of the buzzer alarm so that if people required help they could do so. Some of the bedrooms are en suite which provides a higher level of privacy and independence. It was particularly positive to observe how people had been supported to present their bedrooms in their own style. One bedroom belonging to a clock collector was impressive with all the variety of clocks displayed around the room. In discussion with some of the people they confirmed they had a key to their bedroom or had been offered one. This was also recorded in their care notes. One newly admitted person showed us his room. This had been redecorated and had new bed linen. There was a throw cover for the arm chair and matching cushions. He had a TV provided by Abbeymere. At our last visit we asked that headboards be fitted to the divan beds and observed that this had been done. The people we spoke with were very happy with the facilities. They told us the home is always clean and warm and that they can access their rooms via the lift and locate them easily as each has a decorated name plate. A number of improvements have been made in relation to health and safety and infection control. The last food safety inspection by Dudley MBC was in May 2009 and was very positive which showed hygiene standards to be good. Improvements have been made in the kitchen namely replacing the flooring and food preparation surfaces. A new sluice cycle washing machine has been purchased which is more appropriate than the previous domestic one. Infection control procedures have improved as staff no longer hand sluice items. The home continues to have robust infection control Care Homes for Older People Page 22 of 33 Evidence: procedures and guidelines. Staff wore appropriate protective wear for personal care tasks and paper towels and liquid soap were available around the home and in toilets. Information in the AQAA and training records shows most staff has received infection control training. At our previous visit we asked that bedrail risk assessments be developed further to protect people who need to use them. At thisvisit we saw that the information the proprietor provided in the AQAA is accurate. Three people currently have bedrails. Their files show that the risk assessment is in place and the manufacturer instructions so that staff uses these safely. A monitoring sheet was seen where staff do a visual check each night on the condition of this equipment to identify any complications for use. The people we spoke to told us that the house is always clean and warm and that they feel the house is attractively furnished. Care Homes for Older People Page 23 of 33 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. Staffing levels ensure people have the care and support they need. Staff present as caring and are highly regarded by the people they support. Recruitment practices are safe and staff is generally well trained with some areas identified this could be further enhanced. Evidence: On arrival there were four staff on duty and the care manager. This reflected the staff rota which showed that generally four staff is available on each shift. There were eighteen people being accommodated one of these was in hospital. The staffing information provided to us in the AQAA matched that seen at the time of our visit. The manager told us that there have recently been some staff departures. They have recruited to four vacant posts. The manager said that they had identified some shortfalls in practice related to these staff and are currently working to redress these areas within the home. Observation of staff practice shows staff is very friendly and patient towards people. They talk to people and respond to requests for support. Staff knows the people they care for and demonstrated they can anticipate their needs. Several people who live at Abbeymere spoke about positive relations with staff. They said staff is friendly and helpful. One person told us Abbeymere is her home and she loves it. She said staff is Care Homes for Older People Page 24 of 33 Evidence: pleasant the food is lovely and the home is always clean. Another person told us that the library is well stocked and she enjoys the books. A gentleman who visits regularly described lovely food and good company. Most people could recall requests they had made and staff had met. This included activities and food choices. A person newly admitted was observed to be well supported in settling in. The atmosphere is friendly and staff clearly responsive. We talked to the activities coordinator. On the day we visited a visiting pet scheme was underway. People clearly enjoyed the company of the dog and the opportunity to handle him. A range of activities was on display which demonstrates that staff strives to provide stimulating activities for people. We talked to the cook who said that he is kept well informed of changing needs. He provides a range of homemade meals which the people we spoke with rated highly. Three staff records were looked at which showed that all checks are made before employment to ensure staff are suitable to work with vulnerable people. There is an induction into the home for all new staff telling them how the home runs and their role and responsibilities. The AQAA tells us that seventy five percent of the staff team has achieved NVQ to level 2 and above. Staff has attended training in safeguarding to ensure they know how to recognize the signs of abuse and how to report this effectively. This meets a recommendation made at our last visit. Some of the people require support both with their fluid intake and pressure care. Shortfalls were found in the recording and monitoring of these concerns. A record for turning routines and fluid intake had been inconsistent and demonstrate that staff does not fully understand the importance of robust monitoring to avoid further health complications. Staff training records did not show staff had training in tissue viability and this is needed. The manager was also advised that senior staff must check these records daily to ensure they are identifying any complications and that these are acted upon. Training records for staff show that mandatory training is up to date and or planned. Some staff has also had training in Dementia care sensory deprivation and therapeutic activities. This shows that staff is suitably trained to meet the needs of the people they care for. Supervision records show that staff has supervision on a regular basis to discuss their work and training needs. Yearly appraisals have taken place to ensure staff continues to develop their practice. Care Homes for Older People Page 25 of 33 Evidence: Information taken from discussions with staff and the AQAA tells us that staff meetings take place twice a year. This does not offer a regular opportunity for staff to discuss and share practice issues. In order to improve communication and continuity the manager should work towards a minimum of six staff meetings a year. Care Homes for Older People Page 26 of 33 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 manager and the responsible individual are striving to make continual improvements for the benefit of the people who live at Abbeymere. There have been continued improvements with regard to Heath and safety arrangements which protect people from unnecessary injuries. People can be confident that their views are considered and acted upon to develop a service that meets their needs. Evidence: The proprietor needs to secure registration with CQC for the registration of the care manager. The AQAA informs us that the acting manager needs to complete the leadership and management training to equip her with the skills for the management role.There have been some staff changes recently to include two senior staff leaving the service just after Christmas. However the manger and proprietor appear to be recovering from this shortfall and have identified senior staff to temporarily fill these gaps. The AQAA informs us that these seniors have had competencies training to help them identify their role and responsibilities. A senior spoken with demonstrated a good understanding of her new role. A deputy post has been newly appointed to which will Care Homes for Older People Page 27 of 33 Evidence: strengthen the management team and allow delegation of tasks. Good progress has been made on meeting previous requirements and recommendations. At the previous visit it was identified that staff were not fully aware of the safeguarding process. The AQAA informs us that staff has undertaken training in this area facilitated by Dudley social services. Discussion with staff identified that they have a satisfactory understanding of these procedures and their responsibility to protect people from harm. The proprietor and manager also demonstrated that they understand the reporting process and the importance of joint working with other agencies. There is a quality assurance system in place which includes surveying people who live at Abbeymere for their satisfaction of the service they receive. The results of the last survey indicate people are happy. The service also has a development programme which looks at what improvements are needed and how these will be addressed. An example of this was the purchase of a metal medicine cabinet and staff training in medicine management. It is positive to see the service is working towards consistent improvements for the benefit of people who live at Abbeymere. The proprietor carries out monthly audits and records of this show that he consults with the people who live and staff who work at Abbeymere. Aside from the monthly audits the proprietor visits almost daily and was observed interacting with the people who live there who clearly know him well and enjoy his company. It was evident that people who have had relations with this service remain welcome. A gentleman continues to come to Abbeymere daily for his lunch and said he enjoys the company and the home cooking. His wife had been a resident at Abbeymere previously. There is a renewal programme for the replacement of fixtures and fittings. From this record and the information provided in the AQAA we can see that there has been decoration in the lounge and hall. Chairs have been replaced in the dining room for a more suitable style. Improvements to the building have been made in relation to health and safety. Grab rails have been replaced in toilets which now provide secure support to people who require help with their mobility. A sluice cycle washing machine has been purchased to improve the management of laundry and infection control. A new boiler has been fitted which has improved temperature controls around the house. The staff has received training through the Health and Safety Executive for the use of bedrails. This ensures they are aware of how to use these safely and the need to monitor their use. Monitoring sheets are in place indicating bedrails are checked nightly and the manufacturers instructions are on file so that staff can use this equipment properly. The proprietor has ensured that improvements have been made Care Homes for Older People Page 28 of 33 Evidence: in relation to food safety. Work surfaces and floor covering has been replaced and the recent Food Safety inspection confirmed this. There clearly has been a sustained and consistent approach to improving facilities for the people who live at Abbeymere. There is a system in place to monitor falls and accidents. This record shows the causes and steps taken to minimize these. Since our last visit inventories of property and possessions has been implemented. This ensures there is an up to date record of belongings to protect the possessions of the people living at Abbeymere. A number of health and safety records were looked at. These show relevant checks and servicing of equipment had been carried out to ensure that they were fit for purpose. This includes equipment used to support people such as hoists and the shaft lift. The fire alarm and emergency lighting were being regularly checked and the findings recorded. Staff has had fire safety training. A health and safety audit is maintained this shows regular checks are carried out on the environment to identify any risks and reduce them. Water temperature recordings of water outlets are being taken to ensure water is delivered at a safe temperature and to safe guard and prevent the risk of scalding to people living at Abbeymere. The health and safety procedures that are in place to protect people have been fully implemented. Care Homes for Older People Page 29 of 33 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 30 of 33 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 1 8 12 The management of pressure 15/02/2010 care must be reviewed with urgency and strategies recorded in the care plan. This is to ensure needs are known and recorded in the care plan and monitored so that risk of further health complications is minimized 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 2 3 4 5 6 8 8 8 8 8 18 Daily records should reflect what is actually happening for people with their well being and activities. Fluid records must include Fortisip where this is prescribed. Turning records must include specific details in relation to the times and position. MAR charts signed must correspond with the fluid monitoring record where Fortisip is given. Health care records must reflect health advice from health professionals. More frequent staff meetings would enable the staff team Care Homes for Older People Page 31 of 33 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 to further develop their understanding of protection matters and develop a consistent approach and skills base in this area. 7 8 30 30 To provide staff with guidance on maintaining accurate records for monitoring health care issues. To provide staff with training in Tissue viability in accordance with the needs of individual people who require this support. The acting care manager should complete the Leadership and Management qualification to equip her with the skills for her role. The provider should secure the application for the registration of the manager. The manager should ensure that all records are up to date. 9 31 10 11 31 37 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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