Inspection on 14/11/08 for Aabletone

This inspection was carried out on 14th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aabletone 25/01/07

Aabletone 09/11/05

Aabletone 05/05/05

Aabletone 05/01/05

Aabletone 28/07/04

Aabletone 29/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aabletone Waltham House Stoke Park Road Stoke Bishop Bristol BS9 1JF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Melanie Edwards     Date: 1 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Aabletone Stoke Park Road Waltham House Stoke Bishop Bristol BS9 1JF 01179682097 01179626283 minal@cedarcarehomes.com;aabletone@cedarc arehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Nyakandi Type of registration: Number of places registered: Cedar Care Homes Limited care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 42 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Aabletone is a care home registered with the CSCI, and owned by the Cedar Care Hones Ltd, for 42 people over the age of 51 years who require nursing care and may accommodate 3 persons aged 65 and over who require personal care only. It is a period building with bedrooms on two floors served by a lift. There is a spacious lounge leading onto a patio area and a separate dining room. Most of the bedrooms are for Care Homes for Older People Page 4 of 27 Over 65 42 0 Brief description of the care home single occupancy, but there are double rooms for those who wish to share. The home employs a Physiotherapist who is able to continue rehabilitation work, and also is involved in the provision of activities. There is also a lounge assistant employed who ensures the safety and welfare of the residents who choose to spend their day in the lounge. Care Homes for Older People Page 5 of 27 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We did the inspection over one day and our visit was unannounced. We met twenty of the thirty six residents living at the home. We met the new manager, two registered nurses and four care assistants. We also met the chef. We spoke with them about roles responsibilities training needs and how they help residents. Care Homes for Older People Page 6 of 27 We saw staff helping residents with their needs. We saw the lunchtime meals being served. We saw nearly all of the environment and the only parts that we did not check were a small number of bedrooms. We looked at a number of different records to do with the running and management of the home. These included four residents care plans ,four assessment records, training records, staff duty records, staff supervision records accident records, complaints records, fire records and menus. We found the home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of residents, and the numbers of residents who may stay at the home. The fee range of staying at the home is from 498 to 650 pounds a week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. Residents are having their needs well assessed and well met. Residents and other significant people connected to them have the information they need to make an informed choice about living at the home. Evidence: To give us a really good idea about how people can find out what services there are at the home and what daily life is like, we looked at a copy of the service users guide and the statement of purpose. We saw a copy of both of these documents in home so that anyone can read them. We saw that the statement of purpose and the service users guide contain really clearly written and usefull information about the home. This includes specific information about daily life in the home, fees that are charged the philosophy of care and more information about the service residents can expect. There is also usefull information about the home that residents relatives and significant Care Homes for Older People Page 11 of 27 Evidence: others may find very helpfull. There is a website about the home which offers up to date information to people about the home and servcies provided. We read four residents assessment records to see how well needs are being assessed. The assessment records were really well detailed. They showed the residents range of physical, mental and social needs had been assessed. The actions taken to support the person had also been recorded in the assessment records. The assessments we read had been regularly reviewed and the views of the residents or their representatives had been taken into account. When a new resident is having their needs first assessed the home will put on duty an extra member of nursing staff so that the assesment is done really well and does not impact at all on the care needs of other residents. We talked to the registered nurses about how residents needs are assessed. They told us that the home has key worker system and one of the nurses will take specific responsibility for writing residents assessments and accompanying care plans. The home do not provide intermediate care for residents. Care Homes for Older People Page 12 of 27 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. Residents care plans show very well how needs are met. Residents are treated with respect by the staff who care for them and their privacy is upheld. Medication practises and procedures for the handling of residents medication are partly safe. Evidence: We read four care plans to see how residents care needs are met. The care plans we read had been written in a person centred way to try and set out the residents needs from their perspective. We found that the care plans had clear easy to understand information in them to show how to meet the residents physical nursing needs, psychological, social and communication needs. There is also a part time physiotherapist who supports and assists in assessing residents mobility needs. The care plans had been reviewed and updated on a sufficiently regular basis. This shows Care Homes for Older People Page 13 of 27 Evidence: us that residents care needs are being monitored and kept under review. We saw staff knocking on bedroom doors before entering them and assisting residents in a polite and respectful manner. This shows the staff respect privacy. The residents that we met told us staff are helpful kind and caring when they help them with their care. We saw all of the staff talk to the residents and assist them in a very patient and respectful manner. We also overheard one registered nurse and a care assistant in residents bedroom at separate times. Both staff were really warm and kind to the residents that they were with. We also noticed that the staff use screens to protect the privacy and dignity of residents when they help them to move with the use of a hoist or a stand aid. This is a really good way of maintaining residents dignity at these times. We checked in detail the practises and procedures for giving residents medication and for the storage and disposal of it. We looked at ten residents administration charts. There was a photograph of each resident kept with the chart for identification purposes. The charts we saw were reasonably clearly written. However we saw three gaps when staff had not signed to say the medication had been given or written a reason for why it may not have been given. We also saw four entries on the charts for medicine that was to be given as required . However the entries did not clearly say how often and when the medicine was to be given. Medication stock was generally satisfactorily organised. There was a satisfactory system for ordering and receiving medication and the records were up to date. Medication stock is stored in a cupboard in a movable metal drugs trolley, which is kept in a locked clinic room.There are two metal trolleys is use one for each floor of the home . We saw one of the registered nurses give residents their medication at lunchtime.The nurse was calm and patient and took good time with residents to make sure they had their medication. Care Homes for Older People Page 14 of 27 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. Residents are able to do a variety of different social and recreational things in the home. Residents are supported by the home to exercise choice and control in their daily lives. Residents are provided with a well cooked and nutritionally balanced and varied diet. Residents can keep close contact with family and friends if they so wish. Evidence: We saw good evidence that residents are able to do a range of low key activities in the home. We saw a copy of a timetable of social activities planned to take place on display in the home. This helps to ensure residents are aware of current activities taking place. Activities that are planned to take place include a trips out weather permitting to the shops, arts and crafts sessions, games and musical afternoons. The home also employ a member of staff to work each day in the lounge as a lounge assistant . There job is to engage the residents in social conversation as well as to Care Homes for Older People Page 15 of 27 Evidence: make drinks and snacks for them. We saw a number of residents have visits from their family and friends during the inspection. Visitors said that the staff are welcoming and friendly. Residents and visitors can have lunch together if they so wish. The staff told us there is a relaxed and flexible visiting policy.This benefits residents as this means they can keep in contact with family and friends. Residents told us when we asked them that they are able to choose what time they get up and what time they go to bed. Residents said they are asked about the meal options and their likes and dislikes. There are residents meetings held in the home. These are good way for residents to exercise choices and have some autonomy in their daily lives. We had a sample of lunch the meal was either fish pie with potatoes and cooked vegetables or fish and chips followed by choices of deserts. We found the meal tasty, well cooked and well presented. All of the residents that we spoke to commented very positively about the food served at the home. We also checked the residents menu to find out if residents are consistently provided with a well balanced diet. The meal options seen were nutritionally well balanced and varied. There are choices available each day and staff ask residents what they wish to eat each day. Special diets can be catered for and there are a variety of special meals provided for residents if required.One of the residents told us that if they do not like the main menu choices they only have to ask and an alternative will be made for them. We noticed that residents were being given portions of fresh fruit with their afternoon tea this is a good way the home help to ensure residents eat a healthy diet. Care Homes for Older People Page 16 of 27 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. There is training and procedures in place to protect the residents from abuse. Residents complaints about the service are taken seriously and are responded to well. Evidence: We saw a copy of the complaints procedure on display in the home. All residents get their own copy of the complaints procedure with the service users guide. This means residents have the information they need to make a complaint. The complaints procedure has up to date contact information for the Commission if people need to contact us. Residents said that they see the new manager, (they also saw the previous manager as well ) regularly and they walk around the home to see them. This gives residents a good way to make concerns known to management. The staff we met spoke knowledgably about the subject of abuse and how they protect residents in the home and keep them safe. We saw a policy in place relating to the issue of protection of vulnerable adults from abuse. The policy is to help to guide staff to take the correct course of action if they ever have to respond to an allegation of abuse. The staff do regular training in the understanding of the principle of the Care Homes for Older People Page 17 of 27 Evidence: protection of vulnerable adults from abuse. Care Homes for Older People Page 18 of 27 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. Residents live in a home that is kept clean and satisfactorily maintained. The environment is suitable for residents to live in and has adaptations and equipment in place to help them. Evidence: Aabletone care home is an older property built over three floors.There are stairs and a lift to each floor. The building is over one hundred years old. It is located in a residential area of the suburb of Stoke Bishop. It is near local shops a church and local bus routes. The home is set in its own grounds. The garden looked well maintained. We saw seats and a garden where residents can sit and walk safely. The garden is used to hold social events for residents and their significant others in warmer weather. We saw domestic staff working hard cleaning the home and we found the environment to be clean and tidy. We saw a spacious dining room and a really spacious lounge. We saw residents sitting in communal areas looking very relaxed and comfortable in the surroundings. Care Homes for Older People Page 19 of 27 Evidence: The majority of bedrooms are for single use. Rooms we saw were satisfactorily decorated and maintained. Bedrooms have been made to look more homely and reflected the tastes of residents with photographs mementos and small items of furniture. The standard of furniture and fittings is satisfactory and residents asked said they liked the setting of the home. There is a maintenance worker employed to address general maintenance. We saw service records for fire fighting equipment the lift and electronic equipment. The records showed that external contractors have serviced and checked equipment in the last year. This shows the home is safe and well maintained. We saw that where needed radiators are fitted with covers and windows are restricted which all helps to make the environment safer for the residents. We saw adaptations in the home to help residents and visitors with disabilities throughout building. We saw that bathrooms and toilets were clean and were well stocked with towels and soap to help minimize risk from cross infection. Bedrooms are also en suite and have sinks and toilets in them. Care Homes for Older People Page 20 of 27 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. Residents are well protected by the good staffing levels and also by staff who do a range of training. Residents are generally protected by the homes recruitment practices and procedures, however procedures need to be made even tighter . Evidence: We had a detailed look at the staff duty record for two weeks of November to see if residents have enough staff to meet their needs. There are two registered nurses on duty from 8am to 4pm and seven care staff. There are two registered nurses and six care staff on duty in the afternoon. There will be one registered nurse and three care staff on duty each night. The home also employ lounge assistants whose job is to spend time with the residents in the lounge and engage them in social conversations and also to make drinks for them . There are also cooks and a kitchen assistant and cleaners employed by the Home. However we did not check the numbers of these staff. The manager of the home wokrs full time management hours. We checked the training records of two registered nurses and two care assistants so that we could see if they do a good range of training. We saw evidence that demonstrated the staff had done training sessions and updating over the last twelve Care Homes for Older People Page 21 of 27 Evidence: months. There is now a good number of care staff in the Home who have now completed National Vocational Qualifications in care. The home have their own accredited NVQ trainer who works for the company and supports the staff in completing their NVQ in care awards. We checked the staff employment files of three care staff. We saw two written professional references for each member of staff. We did saw the equivalent of completed Criminal Records Bureau checks for new overseas staff before starting employment at the home. These checks are a further safeguard for vulnerable residents.However one member of staff had begun work with only a completed pova 1st check. We advised that this should only happen in exceptional circumstances. The person should only starts work after discussions with us as to the impact this will have on residents if the they do not start work. Care Homes for Older People Page 22 of 27 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. Residents needs are central to the way the home that is run and it is run in their best interests. Staff are well supervised in their work to help them to better support residents. Residents staff and visitors health and safety is protected. Evidence: The new acting manager has worked at the home since October of this year. They have been a deputy manager of another nursing home in the region for a number of years. The company who own the home also own and run a number of other care homes a senior clinical manager also supports the manager in their work. We were told that staff meetings are held regularly. We saw a sample of recent minutes and these demonstrated staff are consulted and their views listened to by the new manager. Care Homes for Older People Page 23 of 27 Evidence: We checked the finance records of three residents to see what systems there are in the home for looking after residents money. The home will hold residents money for safekeeping if needed to. We could see when we checked the records that the cash and record totals are kept in good order. We were told by the staff that the manager, and the previous manager who had worked in the home for many years are supportive and helpful. We saw good evidence of regular supervision sessions with the staff to assist them in their work and in understanding the needs of residents. Staff do a good range of training in health and safety matters including first aid ,food hygiene training and moving and handling practices. This training for the staff helps ensure residents health and safety is protected. The kitchen staff received a commendable report and food hygiene award from a recent inspection done by Bristol City Council environmental health inspectors. We looked at a recent accident records involving residents for this month to find out what action is taken by the nurses after residents have an accident. The accident records showed the nurses write in detail the nature of the accidents and what may have caused it. They also monitor and follow up if needed, to assist the resident involved in the accident over a period of days after the event. We checked the fire log book record and this showed fire alarm tests and drills are being done and carried out regularly. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Residents medication charts must show how much medication and when it is to be given. Safety of residents and their health needs 28/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!