Inspection on 09/11/05 for Aabletone

This inspection was carried out on 9th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Aabletone 14/11/08

Aabletone 25/01/07

Aabletone 05/05/05

Aabletone 05/01/05

Aabletone 28/07/04

Aabletone 29/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Aabletone Waltham House Stoke Park Road Stoke Bishop Bristol BS9 1JF Lead Inspector Kathy Marshalsea Unannounced Inspection 9th November 2005 10:00 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 Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 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. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Aabletone Address Waltham House Stoke Park Road Stoke Bishop Bristol BS9 1JF 0117 9682097 0117 9626283 mimal@cedarcarehomes.com 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) Cedar Care Homes Limited To be appointed Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Manager must be a RN on Parts 1 or 12 of the NMC register. Staffing notice dated 18/10/2000 applies May accommodate 41 Persons over 50 years of age requiring nursing care. May accommodate up to 3 persons receiving personal care aged 65 years and over 5th May 2005 Date of last inspection Brief Description of the Service: 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 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. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and conducted as part of the annual inspection process. The evidence was gathered in a variety of ways: by observing staff interacting with residents, document reading, having lunch with the residents and discussion with residents, staff and the manager. What the service does well: The home is able to offer rehabilitation services as they employ a Physiotherapist. It also enables the opportunity of exercise and activity for other residents, as the Physiotherapist is also responsible for the activities programme. This is a varied and imaginative activities programme displayed throughout the home. One resident said that they had chosen this home due to them having a Physiotherapist as they did not want to just go into a home and not be able to carry on with the work started by the hospital. They were thrilled with progress made through the programme set by the Physio and couldn’t speak highly enough of her. The home is able to meet all assessed needs either through the existing staff team or by seeking advice from specialists. The home offers a balanced skill mix of staff and sufficient numbers of staff to meet needs in a timely fashion. Staff are kept up to date in mandatory topics such as Manual Handling but also are taught about medical conditions. This is supplemented by the manager ensuring that recent relevant clinical articles are available for staff to read. The manager makes decisions about how the home is run based upon suggestions made by staff, and takes the welfare of the residents into account. The monitoring systems used for quality assurance purposes ensure that there is an objective measure of whether the home is achieving its aims and objectives. Resident surveys are done and action plans implemented to try and ensure that the home is run in the best interests of its residents. Care plans are kept up to date and set out each person’s health and personal needs. Staff are trained to care for the resident who is dying, and their family. The residents value the employment of a lounge assistant. This person provides a continuity of care and provision of individualised social time. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 7 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 Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 Residents can be assured that their needs will be met within the home and specialist advice sought when necessary. EVIDENCE: One resident spoke about his improved condition since coming to the home. The staff team and Physiotherapist had continued the rehabilitation work started by the hospital they came from. When this person came to the home they were in a lot of pain and unable to do anything for themselves. Now they are able to transfer independently, speak clearly, need minimal assistance with washing and dressing and able to go home weekly. The resident was effusive in their praise of the physio, “She is fantastic, and has helped me more than anything. I couldn’t have got this far without her”. Also “the nurses work so hard they are wonderful”. Another example of meeting needs is the case of a resident who has specialist mental health needs. When the home recognised that this was an area they needed expert advice this was sought. Instead of this resident having to move Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 9 to a different home an agreement has been reached to allow this person to stay, but within acceptable boundaries for them and for the staff. The manager is to be commended for dealing so well with this difficult issue. The manager is working towards informing all staff about the specialist needs of each resident by providing training and research based articles about relevant conditions. Trained staff are encouraged to participate in this and so knowledge is cascaded throughout the team. This is commended. A survey was completed at the home in December 2004 to ensure that cultural and spiritual needs aware being met. Actions needed to meet those needs were published and have been achieved. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 11 Care plans set out health and personal needs and are reviewed to reflect changing needs. They need to be developed so that they are more individualised and concentrate on abilities, this will ensure that staff are informed about the whole person. Health care needs are fully met by the staff and other health care professionals. Staff are trained to provide holistic care to those who are dying and their family, so that their death is handled with sensitivity and respect. EVIDENCE: 7. Care plans are developed from a comprehensive pre-admission assessment and other supporting information. The four plans read by the inspector had all been reviewed monthly and changing needs mentioned. Some of these changing needs should have been made into a new plan, for example for anxiety. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 11 Pre-admission identified risks had not been translated into a risk assessment to show clearly that the risk was recognised and minimised. This was particularly so for one resident who came in with two clear problems. While these had been met this had not been well recorded. It was agreed with the manager that it might be more useful to develop the care plan over a short period of time, rather than attempt to do this shortly after admission. Risks should be clearly documented in a risk assessment. The manager stated that she is working towards person centred care plans that are written in the first person. This gives a powerful message for staff to consider the residents perspective, and is recognised as good practice. The inspector looks forward to reading these on her return. 8. There was evidence in the files seen of health care needs being met. This is done by the staff or other healthcare professionals. Risk assessments (Waterlow) are used to determine the likelihood of residents developing a pressure sore and steps taken to prevent and/or treat symptoms. The four pressure sores being treated, some which were present on admission to the home, had excellent documentation enabling it to be possible to track the progress of each wound. This is best practice. One wound, which had been slow to respond to treatment, had been referred to a specialist team. Some problems of continence did not appear to have been subject to a full assessment. As mentioned previously the role of the Physiotherapist is vital in this home for the opportunities for exercise and activity. This has enabled some residents to benefit from a programme of rehabilitation. This is commended. 9. The Pharmacy inspector scrutinized the medication systems. 11. There are Policies and Procedures to assist staff to care for those who are dying. Advice is also sought from the palliative team. The manager spoke about supporting the family and ensuring that spiritual needs are considered. End of life plans were not present in the files seen by the inspector. This should be done so that residents can feel confident that their wishes will be carried out. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 The provision of activities is flexible and varied to suit resident’s expectations, preferences and capabilities. Residents can choose what they eat and are offered a varied and wholesome diet. EVIDENCE: 12. The inspector spent some time in the communal lounge. It was evident that the role of lounge assistant is valued by the residents, one of whom said,” I feel safe with Sue because she cares”. She supported residents to drink, pass the time and go to the toilet. She also served drinks and helped those who needed assistance with their meal. It was observed that at times help was needed by the lounge assistant to meet the needs of residents, eg with walking. This was difficult to get promptly due to the fact that other staff were busy. The manager has already recognised this and is changing the use of the nurses’ station so that the staff begin to sit in the lounge too. This should resolve this problem and will be assessed at the next inspection. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 13 The activities log shows a varied and frequent programme, which includes who joined in which activity. The manager stated that she is going to develop the daily notes for each resident by including how someone enjoyed or reacted to an activity. This is commended and should enhance the activities provision, particularly for those residents who cannot communicate. 15. The inspector joined the residents for a mid day meal. One resident told the inspector “the food is quite good and that we are always offered choices.” The meal was served to us in an unhurried manner. The meal was very pleasant and tasty. It was noted that not all residents came into the dining room. In fact there were only a few residents at the tables. Some had their meal served in the lounge. This was discussed with the manager who stated that usually most residents who are not in their room are encouraged to come to the dining room. The trained nurse should be supervising this process. This may not have happened because there were two care staff on duty that were from another home, who were unfamiliar with this home’s routine. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Although these standards were not assessed it was noted from staff records that some staff have attended recent training in the prevention and detection of abuse. There were also documents by the nurse’s station relating to this topic and including the document “No Secrets”, the Department of Health adult protection policy. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not fully assessed. It was noted that since the last inspection the quiet lounge has been converted into a very pleasant dining room. This has given more space in the lounge. The patio area reached through French doors contains raised planters allowing residents the opportunity to be involved in gardening even from a wheelchair. This is commended. One resident commented on how often they use the patio even when the weather is unfavourable. The inspector was taken around the building and noted that it looked clean and tidy. One large single bedroom has now been officially registered to be a double room allowing a choice of how the room is used. The inspector viewed this room, which is currently occupied by two residents. The inspector was Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 16 informed that it was the resident’s wish to share this room. This has increased the number of registered nurses beds from 41 to 42. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Staffing numbers and skill mix of staff are appropriate to meet the assessed needs of the residents. Residents are protected by the home’s recruitment practices. Residents can be assured that their needs will be understood as staff are kept up to date, and are trained to do their job. EVIDENCE: 27. Rotas seen confirmed that the home is consistently meeting its staffing notice. This ensures that the minimum of staff needed are on duty. The staff are allocated work according to the named nurse and named carer system. This ensures that there is a range of skills and experience in each area of the home. As mentioned previously the lounge assistant and Physiotherapist compliment this team. The manager is supernummary to the numbers of staff on duty. She is currently recruiting for an administrator to support her in her role. 28. Three care staff have achieved their NVQ 2 in care. At the moment 7 other care staff are at various stages of completing theirs too. This should ensure that the care staff are knowledgeable about the care of residents. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 18 29. The area of recruitment was discussed with the manager. She was able to demonstrate her knowledge of the requirements of the current legislation. The records of a recently employed member of staff were examined. As this person came from abroad an agency was also involved in this process. Most of the documents needed were present apart from the proof of identity. The manager stated that she had taken a copy of this person’s passport for this purpose. A Police check from their country of origin was there and the manager was aware of the need to do a Criminal Records Bureau (CRB) check once they had been in this country for 6 months. This is according to CRB recommendations. The inspector saw an equal opportunities audit undertaken October-December 2004. This confirmed that equal opportunities are observed. 30. Training records were examined. These showed that staff are offered and attend mandatory training such as First Aid, Manual handling, Food Hygiene and Fire Safety. Other courses attended were for Challenging Behaviour, Palliative care, Abuse, Catheter care, Pressure sore management, Dementia and Parkinson’s Disease. This should ensure that staff are trained and competent to do their job. The manager has introduced a regular training session for staff in subjects relating to conditions experienced by residents. She showed the inspector the content of two of these sessions, which are based upon research-based articles. She is also using nursing journals to raise staff awareness in relevant topics. This is commended. The inspector saw that the home are using the TOPPS induction traing booklets. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37, 38 Residents and staff benefit from a manager who is competent and able to run the home to meet its purpose. Residents and their relatives can be sure that their views will be sought about how the home is run and suggestions actioned. Fire safety measures are in place to provide a safe home. EVIDENCE: 31. Mary Nykandi has almost completed the fit person process to become the registered manager of this home. She was interviewed by two inspectors and was able to demonstrate her competency at this interview. 32. Evidence gathered during the inspection confirmed that staff and residents benefit from her management style. The organisation empowers her to make Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 20 decisions about how the direction she would like to go. This is then introduced to the staff for suggestions and solutions to be agreed by them. Minutes were seen of a residents/relatives meeting where the same principles applied. 33. The inspector saw evidence of surveys done to ascertain whether the home is run in the best interest of the residents. An action plan to meet any suggestions was seen and when this had been achieved. 38. The Fire Log showed that records are kept of the safety tests, drills and staff training all done at the stipulated intervals. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 21 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 X X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X X 3 3 Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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. 1 Standard OP38 Regulation 13(4)(c) Requirement Complete risk assessments on admission so that any risks are communicated to all staff. 16/11/05 One risk assessment for a resident identified during the inspection needs to be rewritten. 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 2 3 4 Refer to Standard OP7 OP7 OP8 OP11 Good Practice Recommendations To personalise the care plans by using person centred care planning. To complete short-term care plans when a new need has been identified in the reviews. For all residents who have a continence problem to have this fully assessed For all residents to have end of life plans. Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 Aabletone DS0000020261.V249810.R01.S.doc Version 5.0 Page 24 - 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. 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