Inspection on 15/05/07 for Abbegale Lodge

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbegale Lodge 02/06/10

Abbegale Lodge 18/03/10

Abbegale Lodge 06/10/09

Abbegale Lodge 17/06/08

Abbegale Lodge 07/02/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Abbegale Lodge 9-11 Merton Road Bootle Liverpool Merseyside L20 3BG Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 15th May 2007 08:45 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 Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbegale Lodge Address 9-11 Merton Road Bootle Liverpool Merseyside L20 3BG 02086703873 Telephone number Fax number Email address ovider 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) Mr Ramesh Chander Parkash Sabberwal Miss Brenda Bailey Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. One named out of category service user in the category of Learning Disabilities. This variation applies to the named service user only. Should they leave the home, the variation will cease to apply. Ramp access to be provided to the home within six months of registration. One named service user under pensionable age Date of last inspection 7th February 2007 Brief Description of the Service: Abbegale Lodge is an established privately owned care home that is registered to provide residential care for 41 older persons. Mr Ramesh Chander Parkash Sabberwal recently purchased the home in September 2006. The registered manager is Miss Brenda Bailey. The service is situated on a busy road close to bus services and a train station. It is within easy distance of local amenities. The service is set out as two converted Victorian villas with a two storey modern extension. There is lift access to the main building with a stair lift in place to the other villa and extension. A new ramp access is now provided to number 11. The service has a call bell facility in residents’ rooms and public areas. The service provides upper and ground floor accommodation with lounges and dining rooms in each area. A large rear garden and off street parking is available to the front of the premises. Weekly fees are £355.50 Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted 8.5 hours. This was the key unannounced inspection to be carried out as part of the regulatory requirements. Thirty-seven residents were residence at the time of the visit. As part of the inspection process all areas of the home were viewed including most of the residents bedrooms. Some of the residents care records; staff records and service records were inspected also. Discussion took place with Mr Sabberwal, who is the registered provider and Miss Bailey, the registered manager. The inspector met with many of the residents and spoke on a one to one basis with five residents. Residents’ views on how the home was run were gained during these interviews. The inspector also had discussions with some of the care staff and interviewed two on a one to one basis. One visitor to the home was interviewed also. At the time of the visit, four residents were case tracked (their care records were examined and some of their views were obtained). All of the key standards were assessed. Residents’ views were also obtained through Have your say about ….questionnaires, which were sent to the service prior to the inspection. There views are included in this report. What the service does well: During resident interviews many gave positive feedback about how they live their lives with comments such as, “staff are very nice”, “we are well looked after”, “staff are lovely, nice, kind and lots of patience”. One of the residents interviewed is keen to have some friendly banter with staff and stated, “I get on smashing with the staff, we have a laugh and a joke together”. All of the residents interviewed confirmed that staff treated them courteously and with kindness. The home continues to access a District Nurse to provide healthcare for one of the residents and the resident confirmed this, stating, “the District Nurse visits every week and I’m happy with the care”. Residents interviewed stated, “staff are gentle when helping with my shower”, “the Doctor visits and they are very good and I get my medicines on time”. Another resident interviewed stated, “the food is brilliant, we are asked each day and given a choice”. A visitor to the home confirmed that residents enjoy their food and get home baking and stated, “there is plenty of food, fresh fruit and vegetables”. Other residents confirmed that they enjoyed the meals served in the home with one resident commenting I would like scrambled eggs Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 6 and tomato for a change” and other comments include, “I enjoy all the food” and “I always enjoy my meals”. Abbegale Lodge has an open visiting policy and a visitor interviewed confirmed this, stating, “staff make me a cup of tea and make me feel very welcome”. When asked of their views about Abbegale Lodge a visitor stated, “It’s fantastic, I couldn’t fault it. Residents interviewed about their routines confirmed that they were able to retire and get up when they wished to and come and go as they wished. One resident interviewed stated, “I go to the shops on my own using my stick”. All of the residents who were interviewed were happy living a t Abbegale Lodge with one resident stating, “it’s like home from home”. What has improved since the last inspection? The pre admission process of assessment has improved therefore residents needs will be more easily identified and therefore managed better. The new documentation was used with the most recent admission to the home and this is much better than previous. It is well organised and most of the residents’ needs that were identified have been implemented in their individual care plans. There have been improvements with regard to care plan documentation and residents accessing other health professionals. This is much better than last time and there is evidence of residents’ signatures agreeing to their care with regular reviews evidenced also. Residents’ weights are recorded on a regular basis and Waterlow (pressure relief tool) scores are recorded. Manual handling assessments are evidenced in the residents’ files viewed. There has been some improvement in the administration and management of medication. The manager has recently changed the pharmacist who supplies to the service. The new pharmacist has been able to supply training for care staff and provided new storage facilities for the residents’ medication. There is one completely smoke free lounge for residents at number 9. The service has much improved access throughout for residents. A new ramp has been fitted to No 11 and stair lifts have been fitted to the houses to ensure easier access for residents’ who need this facility. One resident interviewed stated, “I use the new stair lift every day, it makes a big difference as I don’t have to use my inhaler at the top of the stairs and my legs are much better also”. Some of the residents’ bedrooms have been redecorated and reception areas and hallways have been redecorated also. New dining furniture has been provided for two of the houses and new armchairs also. Residents interviewed Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 7 confirmed that they were very happy with the improvements and one stated, “I’m happy with everything, the new owners were told that our tables were disgusting and had the new ones in place fairly quickly, anything we ask for we get”. Staff training has improved with most of the staff attending mandatory training in February and March this year. The manager’s hours are now identified on the rota. The fire alarm is now tested weekly. The fire logbook evidences measures carried out with regard to fire safety and a fire risk assessment has been carried out for the premises. A new fridge thermometer has been purchased and is now used to ensure food is stored at the correct temperature. What they could do better: The management of medication has improved but there are some problems that still need to be resolved to ensure residents are not put at risk therefore the service will be asked to follow an improvement plan to ensure residents are not placed at risk. Residents are generally happy with their lifestyle but Abbegale Lodge needs to review the activities programme with the residents so that they can ensure suitable and regular activities are organised to prevent residents feeling isolated. Residents’ choice needs to be promoted with regard to privacy and the supply of keys to their bedroom doors. The service also needs to provide residents with individual lockable secure facilities in their bedrooms. The complaints process has improved but there needs to be a more structured record kept of any complaint raised with a full account and outcomes for residents recorded. The service needs to improve their policies and procedures with regard to residents’ finances and valuables and ensure they are put into practice. The service has made some improvements, which has benefited the residents, however this needs to continue through the planned programme of refurbishment and upgrade to suit the needs of the residents. Although the mandatory training has improved the service still needs to ensure that all staff attend all up to date mandatory training to ensure residents and staff are not placed a t risk. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 8 Abbegale Lodge is a safer service for residents although some staff training still needs to be implemented to ensure all residents and staff are protected. 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. The summary of this inspection report can be made available in other formats on request. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The pre admission process of assessment has improved therefore residents needs will be more easily identified and therefore managed better. This judgement has been made using available evidence including a visit to this service. Op3 was assessed. Op6 is not applicable. EVIDENCE: Prior to being admitted to the home prospective residents are assessed by the manager. Prospective residents are invited to the home prior to admission so that they can view the home, meet the residents and staff and view the bedroom’s’ on offer. One resident interviewed confirmed that they had been unable to visit the home and their friend had on their behalf. Another resident stated, “my daughter visited the home”. Other residents interviewed were unable to remember but some thought that their relatives had helped. Four residents were case tracked (looking at all documentation with regard to care for the individual resident). Three residents had been admitted to the home prior to the new pre admission assessment process. Two of which, have Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 11 been in the home some years. One other resident (GL) has been in the home since before the last inspection and their assessment was documented but not signed or dated. New documentation with regard to assessment of residents is in place and confirmed that the pre admission assessment takes place. The new documentation viewed evidences much more information is gathered during the pre admission process therefore this process has improved and is much easier to follow. One of the most recently admitted residents (GB) care documentation was examined with regard to his pre admission assessment. The manager visited this resident in hospital to assess their needs. A copy of the nursing assessment is in place with dates included. The reason for admission to the home is noted. Personal details are on file. The prospective resident’s partner visited the home and then the resident did prior to admission. Personal and specialist needs have been recorded. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. There have been improvements with regard to care plan documentation and residents accessing other health professionals. The management of medication has improved but there are some problems that still need to be resolved to ensure residents are not put at risk. This judgement has been made using available evidence including a visit to this service. OP7,8,9,10 were assessed. EVIDENCE: The manager has improved the care plan documentation considerably since the last inspection therefore making it easier to follow. Care files are much more organised and residents’ needs and management of them are clearer. All four residents chosen to be case tracked had a care plan in place. Four residents care plans were examined: Three of the care plans have been agreed and signed by the resident. One care plan hasn’t. Therefore this needs addressing. The care plans examined contained information regarding most of the residents’ healthcare needs. Staff review the care plans monthly and are signed by residents and staff with dates included. One resident has diabetes controlled by medication although documentation evidences that the Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 13 resident likes all foods and is not on a special diet. The manager was advised to ensure the resident is provided with a diabetic diet to ensure their health is not compromised. One resident has a poor appetite and has other serious health problems therefore a nutritional assessment needs to be put in place to ensure they are not nutritionally compromised. This resident has also been identified as at risk of falls and although this has been documented in the overall risk assessment a clear and detailed management of this risk needs to be in place. A resident has been sick on several occasions yet this has not been documented and addressed in their care plan. This resident has also not received their prescribed medication for one day and the home is due to run out of stock yet again for the same resident. Since the previous inspection in February this year the service have made some improvements in the management and administration of medications, which was evidenced by the Commissions’ pharmacist during this inspection visit. The manager has recently changed the pharmacist who supplies to the service. The new pharmacist has been able to supply training for care staff and provided new storage facilities for residents’ medication. The home has now got three new medication trolleys, which enables each building to have it’s own storage. As a result of the pharmacists visit some requirements have been made and it has also been decided that an improvement plan is necessary also. Personal care is addressed and the assistance/support from staff identified. One resident interviewed stated, “I have a shower with help”. There is evidence of signed consent for staff to administer residents’ medication. GP and other health professional visits are documented. One resident interviewed stated, “the District Nurse visits to see to my leg ulcers, I’m happy with the care and the Doctor visits and they are very good, I am happy with the care from staff”. Other heath and personal care needs are identified in care plans including sleep pattern, mobility and communication. Residents interviewed confirmed that they received visits from chiropodists, opticians, dentists and attended hospital for additional medical and specialist support. One resident interviewed stated, “it took me ages to get a dentist, some dentists were full, so we wrote a letter, Marie (senior carer) was very good, she got me an appointment and one carer to escort”. Some of the residents have not got sufficient information with regard to their oral health therefore the manager was advised to ensure that documentation evidenced if residents had their own teeth or not and if they wore dentures. It would be of benefit to residents’ health if it were known when their last appointment was with their/a dentist. An appointment can then be made for residents who need dental check ups. During the unannounced inspection the inspector met with many of the residents and observed that all were wearing suitable clothing. Residents spoken with agreed that staff are respectful and supportive in their approach. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Residents are generally happy with their lifestyle but Abbegale Lodge needs to review the activities programme with the residents so that they can ensure suitable and regular activities are organised to prevent residents feeling isolated. Residents’ choice needs to be promoted with regard to privacy and the supply of keys to their bedroom doors. This judgement has been made using available evidence including a visit to this service. OP12,13,14,15 were assessed. EVIDENCE: Residents interests and hobbies are documented in care files therefore this gives staff some information on how the residents like to spend their time. Residents at Abbegale Lodge were canvassed for their views through the Have your say about ……questionnaires issued by the Commission. Comments from residents include, “there are never any activities that I can join in”, “not enough activities” and “I would like to go to bingo more”. One resident interviewed stated, “there are activities in the three houses, we watch films and play games, myself and two ladies go in a taxi to the Strand”. Another resident interviewed stated, “my friend takes me out, I went to York to visit Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 15 my son on Friday. A visitor to Abbegale Lodge stated, “they don’t seem to have activities, they just sit down and watch telly”. Staff interviewed stated, “there are not really any activities”, “more staff would be better, if there were more staff we would have more time to take residents out in nice weather”, “there are no activities for residents, we haven’t the time” and “DVD’s on Sunday, residents not yet out this year, we are going to the Botanic gardens for August”. At present the home is not providing sufficient activities for the residents. It would be advisable for the manager to canvass residents for their views on what type of activities they would like. When this information is available a list of activities with times, dates should be put into action and reviewed throughout the year with the residents input. Residents who do not smoke in the flats have to sit in the same lounge where other residents do, as they have no other choice. The inspector observed this during the inspection visit. This issue was discussed at the previous inspection. In one of Abbegale Lodge houses, one sitting room/dining room is allocated to non-smokers. In the other two houses it is still a problem. The registered provider is hoping to extend the public living space on the ground floors and is at present looking into this, which will help to resolve this problem. The resident who wishes to have their own bedroom has been offered a new bedroom in the ‘flats’ but has refused as he wishes to have one in the same building as he presently lives in. There is none vacant at present. Holy Communion is arranged at Abbegale Lodge for the residents who wish to participate. One resident who is Church of England stated, “I am C of E they don’t have Communion, I would like to go to Communion”. The resident agreed that the manager could be advised of their comments. The manager is to arrange this. Many residents have regular contact with their families and friends. This was observed during the inspection visit and confirmed during discussion with residents. Residents interviewed confirmed that they were generally able to live their lives as they pleased. Residents are able to retire to bed and get up when they wish. One resident interviewed stated, “I go and put myself to bed when I want to”. This is also evidenced in care plans. There are no restriction on visiting times with residents and a visitor confirming this. One regular visitor to the service was complimentary about the meals served to their friend stating, “the food is lovely ‘she enjoys it she had lamb, they had lamb stew she eats everything they make pies and scones and there is plenty of food, fresh fruit and vegetables, bananas and apples. Residents interviewed stated, “I enjoy all the food”, “I always enjoy my meals”, the food is very good” and “The food is brilliant, we are asked each day, given a choice”. During the inspection visit residents were suitably dressed and well groomed. A visitor interviewed stated, “they always keep …. smartly dressed they make Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 16 sure they are all nicely dressed”. Meals are served to the residents in the dining areas of two of the houses and a separate dining room in the other house. The kitchen was viewed during the inspection and it was organised and clean. The menu on display offered choices. The meals served looked appetising and nourishing. Residents were not rushed at mealtimes and staff were noted to be assisting residents discretely. Two of the dinning areas have now got new furniture, which residents were very pleased about. Residents were delighted with the new dining furniture with one resident stating, “the new owners were told that our tables were disgusting, and had the new ones in place fairly quickly”. Staff were observed to be courteous and kind to residents during this visit and residents and a visitor to the home confirmed this. Most of the residents do not have a key to their bedroom doors therefore compromising their privacy. The manager was advised to assess the suitability of individual residents and provide a key to those who wish one and are thought to be able to use this facility. Staff were noted to knock on residents bedroom doors during the visit. Residents interviewed confirmed that this was usual. Residents’ bedrooms contained various items, ornaments and pictures that they had brought in from home, which personalised their bedrooms. Local advocacy group contact details are available for residents. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The complaints process has improved but there needs to be a more structured record kept of any complaint raised with a full account and outcomes for residents recorded. The service needs to update polices and procedures with regard to residents finances and valuables and ensure they are put into practice. This judgement has been made using available evidence including a visit to this service. Op16,18 were assessed. EVIDENCE: The complaints log is evidenced in a diary and is unstructured. Concerns raised by some of the residents have been recorded and addressed. There is insufficient information with regard to complaints/concerns raised. The manager was advised that a more suitable document should be used. Advice was given to the manager to ensure the complaints book was able to contain the information required with regard to any complaint received including a record of a full investigation, dates, statements and signatures and outcomes addressed. Some of the residents interviewed were aware that the service had a complaints procedure. One resident interviewed stated, “I know how to make a complaint”. Other residents interviewed were confident that any concerns they had would be listened to. One resident interviewed stated, “Brenda (manager) is very helpful to residents especially, she is very good”. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 18 The service has a copy of the Sefton Adult Protection Procedure. A complaints procedure is available to residents in a leaflet format with the Commissions contact details. Abbegale Lodge has no valuables book therefore the manager was advised that this was necessary to ensure any valuables held by the home have been recorded and receipts given to residents/relatives where needed. The manager stated that, “we don’t hold any”. Most of the residents do not have keys to their bedroom doors or a lockable facility in their bedrooms. The manager was advised that this needs addressing to ensure that residents can store any valuables securely. Records are kept of financial transactions for residents. Some of these were viewed on the day of inspection. The manager stated, “audits are carried out by myself and senior staff”, but there is no record of this therefore the manager was advised to address this. One visitor to the home advised the inspector that they purchased clothing and other items for their friend and had yet to be paid for it. This was discussed with the manager. The manager stated that, “we hold the receipts for the items bought and are awaiting to hear from the solicitor”. The resident has their own solicitor therefore the manager was advised to contact the resident’s solicitor so that the receipts could be passed on. This needs to be put on a more formal footing with the solicitor, resident and her friend. The service also holds a locked ‘money box’ on behalf of one of the residents. The manager stated, “I have no idea what is in the box”. There is no record of this. The manager is advised to speak with the resident and her advocate and arrange a more formal, documented process of storage to ensure this resident is not placed at risk of financial abuse. There is ‘Alerter’ training available therefore the manager was advised to try and ensure senior staff accessed this as it would enhance their understanding of adult protection. Policies and procedures with regard to residents’ money and financial affairs should be reviewed and updated also. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The service has made some improvements, which has benefited the residents, however this needs to continue through the planned programme of refurbishment and upgrade to suit the needs of the residents. This judgement has been made using available evidence including a visit to this service. OP19,22,24,26 have been assessed. EVIDENCE: Since the new owners have been in place, a planned refurbishment schedule for the service from 2007-2008 is in place, as many areas of the service require improvement including residents’ bedrooms. A suitably qualified person carried out an assessment of the premises and their recommendations have been included in the improvement plan. The registered provider Mr Sabberwal had toured the Abbegale Lodge with the inspector during a recent visit and discussed the plans for Abbegale Lodge. The first items on the Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 20 improvement plan were to improve access to all areas of the service for the residents who live there. Also included in the initial stages of the improvement plan was to redecorate public areas and residents’ bedrooms. The inspector and manager toured all three ‘houses’ during the inspection visit including most of the residents’ bedrooms. With regard to the first ‘house’, (NO 11 the first building): A new stair lift to the first floor has been fitted, which enables residents to use this facility to access their bedrooms. A ramp has been fitted to the front area of the house so that residents are able to access the home safely and staff are able to use this facility with any residents who use wheelchairs. Bedroom 12 has been redecorated with new curtains, bedding and carpets yet to be fitted to complete the upgrade. The hallway, and woodwork has all been redecorated including the rear dining room. The front sitting room ceiling has been painted and the rear dining room has been decorated. There is no separate smoking room yet. 9a Flats: Bedrooms 21 and 30 have been repainted. Bedroom 20 has been completely upgraded by the resident’s family with new furnishings also. All of the armchairs have been replaced in the lounge. A chair lift has been fitted to enable residents to access the first floor. Residents interviewed stated, “I use the new stair lift every day, it makes a big difference as I don’t have to use my inhaler at the top of the stairs and my legs are much better”. 9: The lounge walls, ceilings and window shutters have all been painted. New blinds are in the process of being put up. The furniture has been moved around and new armchairs are in place in the rear lounge. The rear lounge has been repainted and is now the appointed non-smoking lounge. New chairs and dining tables are in place. The hallway and front entrance has been redecorated. Bedroom 5 has a new light in situ as recommended for residents’ safety. When the resident accesses the bedroom, the light comes on when the door is opened. The registered provider visited the home during this inspection and pointed out the new lighting system fitted to the hallway and stairs separate to the main entry staircase. The new lighting system ensures that the stairs and landings are always lit continuously throughout 24 hours therefore making it safer when residents/staff use the hallway and stairs. Previously this area was very dark and lights were off. Therefore this is a big improvement for residents. A new coded push lock is in place at the top of basement stairs to ensure residents do not access the basement area. Staff interviewed stated, “the home is being repaired, the new owners are taking an interest, they come in three times a week and usually stay for the whole day”. The manager also pointed out bedrooms that were identified and prioritised as needing to be refurbished this year. A further plan from 2008-2013 viewed by inspector includes the plan to continue with the refurbishment of the residents’ bedrooms. Included in this there is a possibility that the service may apply to Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 21 extend 9 and 11 to include moving and improving public sitting rooms, accommodating other facilities including a hairdressing facility and improving en suites to bedrooms. Maintenance books for each building are on a diary format with entries and signature present but no date included, therefore this needs addressing. The service is at present having problems accessing a suitable gardener and this is evidenced as the rear gardens are overgrown and they need weeding and the grass cut. The owners have been trying to cut the grass but unfortunately unsuitable equipment had let them down. On the day of inspection an additional more suitable lawn mower was in use. The front garden has many flowering shrubs and just needs a little weeding. Garden furniture for the use of residents and their visitors is available. The service needs to provide locks to residents’ bedroom doors that are suited to the residents’ capabilities and provide the residents with keys following risk assessments. Residents’ also need to have an individual lockable facility in their bedrooms for storage of valuables/medication. Care plans should evidence if the resident holds the key and if not, why not. During a tour of the service it was noted that all areas of the service were clean and odour free. The shower mat in the ‘flats’ was very mouldy therefore the manager was advised. This was thrown out during the inspection visit. Residents interviewed stated, “my bedroom is cleaned every day”, “the home is cleaned every day” and “overall the standard is reasonable”. Laundry facilities are sited in the basement area on a separate floor from the kitchen. A cleaning rota is in place in the kitchen with the cook carrying this out at then end of each working day. A smaller kitchen area is available in the ‘houses’ for residents use to make drinks/snacks. The manager was advised to carry out a risk assessment on these kitchen areas and also on the residents who use them to ensure they are safe. Two care staff were observed by the inspector to be ‘helping’ in the kitchen wearing their carers uniform without aprons. The manager was advised to ensure that any care staff that transfers to work in the kitchen following care work must change their uniform and wash between duties. A call bell facility is fitted throughout the service including residents’ bedrooms. Some of these were tested during the visit and worked effectively. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Although the mandatory training has improved the service still needs to ensure that all staff attend all up to date mandatory training to ensure residents and staff are not placed at risk. The pre employment process of new staff needs to be improved to ensure all residents are protected. This judgement has been made using available evidence including a visit to this service. OP27,28,29,30 were assessed. EVIDENCE: The staff rota now evidences the managers’ hours. There is two domestic staff on each day but no laundry support. There is two care staff on duty in each ‘house’. Two of which are senior care staff. Residents interviewed confirmed staff were very busy. Staff interviewed confirmed this and stated, “some days we are really busy but generally we have the time, we could do with a laundry lady”. All staff that provides care are over 18 years old. Staff interviewed stated, “I love it I love the atmosphere, it’s great”, “there is enough staff on duty we never really work short staffed”. Staffing levels need to be kept under review to ensure staff have the time to provide and support residents with activities. Some of the care staff has an NVQ qualification in care but additional junior care staff should be encouraged to take this up. One of the senior carers may Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 23 be interested in taking further NVQ qualifications therefore this will benefit the residents greatly. Residents were very complimentary about the staff employed in the home. Residents interviewed stated, “staff are very nice, I get on smashing with all the girls, we have a laugh and a joke together”, “I have no fault with the staff, Brenda (manager) is very good”. Not all of the pre employment checks taken out for employees are in place. Three staff files were examined. Two staff files checked evidence CRB (Criminal Record Bureau). The other staff file checked was for a recent employee and the manager was advised that an up to date CRB and POVA (Protection of Vulnerable Adults) check was needed. Applications forms are in place for all three and written references are in place for two. A new employee file evidences just one reference therefore the manager was advised to address this. Brief employment/education history is in place. Medical staff questionnaires are in place. A statement of terms and conditions is in place for one staff therefore the manager needs to ensure that other staff employed has a copy also. Only one staff file evidences an induction was carried out therefore the manager needs to ensure that all staff has an induction to their work and that this is evidenced in staff files. Staff interviewed stated, “I’ve not been shown how to use the ‘medi’ bath it would be good to be shown how to use them”. Two members of staff ‘drag lifted’ a resident whilst transferring the resident from an armchair to a wheelchair. One of the staff is a domestic. The inspector, manager and senior witnessed this transfer. It is important that care staff are trained and assessed following their training to ensure they are able to transfer residents correctly. This will ensure residents are not placed at risk of injury by poor transfer methods. The domestic staff should not be involved with patient care. All staff employed must receive a structured induction to ensure they have the skills and knowledge to provide care and support to the residents. Staff files evidence some of the training carried out including, fire training, oral hygiene, infection control, POVA, medication, NVQ, basic food hygiene, manual handling, first aid, COSHH (Control of Substances Hazardous to Health) and health and safety. None of the staff files checked evidenced that Equality and Diversity training had been attended. The manager has made improvements to ensure more staff has attended mandatory training but not all of the staff files evidence that all mandatory training is up to date therefore this needs addressing. It would be of benefit to the service if staff attended up to date training with regard to elderly abuse. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Abbegale Lodge is a safer service for residents although some staff training still needs to be implemented to ensure all residents and staff are protected. This judgement has been made using available evidence including a visit to this service. OP31,33,35,36 were assessed. EVIDENCE: The registered manager has been employed for three years. She has gained the Registered Managers Award in 2006. The manager has not attended any further training since October last year. The manager has not attended any fire training in the last year therefore this needs addressing as a matter of urgency. (Since the inspection visit the manager has booked fire training for herself). It is important that the manager can demonstrate that she has Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 25 undertaken periodic training to update her skills, knowledge and competency whilst managing the home. Through discussion with staff the inspector was made aware of their understanding of the varying conditions and disease of older persons. As discussed previously there is an annual development plan for the home, which was viewed during this inspection. The manager has planned to carry out residents meetings three times each year. The minutes of the most recent one of 5/3/07 was viewed. The residents meeting included the new owners and manager. Many issues were discussed including the planned refurbishment of the service, door locks for residents’ bedrooms, recliner chairs, aerial for televisions and more wardrobe space requested for a resident. Residents interviewed confirmed that they had attended meetings for the residents and were being kept informed of all the changes with regard to improvements for the service. Staff meetings are being held on a regular basis also. The most recent staff meeting was held on 9th Feb 07. The minutes show a list of the staff that attended and the agenda included the recent Commission’s findings following inspection, when various areas were discussed. Quality assurance surveys were given out to residents with regard to how the service is run in January 2007 and ten were returned. Questionnaires returned gave fair to good feedback about how the service is run. The main concerns raised by the residents in the returned questionnaires are the lack of activities and outings. The manager is planning to send out relatives’ questionnaires. Policies and procedures have been updated to include disciplinary and grievance, equal opportunities, admission of new residents, Dr’s visits, missing residents, dignity, privacy confidentiality, disposal of clinical and domestic waste, kitchen, food and safety standards, residents property, discharge policy, statement on hot water, care of the dying, death of resident, food poisoning gastric outbreaks and annual leave /public hols. The mission statement and aims and philosophy of Abbegale lodge have been updated. Abbegale Lodge has made an effort to try and implement requirements identified at the last inspection within the timescales. Some of the requirements have been implemented. Financial records and residents security of valuables has been discussed previously in this report. Abbegale Lodge has sufficient insurance in place. Manual handling training is up to date for most staff. All staff has attended fire training now except for the manager and another member of staff who is on maternity leave. Merseyside Fire Brigade visited 3/07 following a small cigarette fire. Recommendations were made following this visit by the fire Brigade which included no smoking in residents bedrooms; the medi bath door to be fixed (site of fire) and the fire exits to be checked. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 26 A fire risk assessment was carried out by the service and a copy sent to Merseyside Fire Brigade. Quarterly fire visit checks are carried out with the contracted company for No 9,9a and 11. Fire alarm checks and door releases checked 9/5/07. On 26/3/07 the fire extinguishers (water ones) were refurbished as the pressure was too low and they needed refilling. Fire Reliant Ltd visited 10/5/07 Extinguishers, and fire blankets checked throughout the building. The fire logbook was viewed. First aid boxes are in the kitchen, office, 9a, 9 and 11. The kitchen one was checked and had sufficient recommended creams/dressings. The District Nurses are responsible for sharps. Hazardous substances are secure. All servicing, maintenance certificates were viewed and are in date for all appliances and equipment at the home. Portable appliance testing has been carried out this year although the person who carried it out does not hold a recognised qualification therefore the service are in the process of accessing a more suitable and qualified person for this task. Hot water bath temps are done before each bath and recorded in the charts in bathrooms. Hot water temperature checks need doing and documented. A discussion took place with the manager to ensure that residents’ bedrooms are risk assessed to ensure that residents are safe in their rooms. The service has not yet been tested for Legionella but the manager and registered provider have been planning this and have also arranged a further package, which will enable the service to carry out recommended procedures following the formal test. The manager has recently commenced risk assessments for all safe working practices and is in the process of documenting this information. A risk assessment of the building has been carried out. Accident records were viewed and records kept are clear. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 (2) (a)(b)(c) (d) Requirement The registered provider must ensure that residents care plans, identify the management of residents at risk of falls, diabetic diets and the resident who is prone to episodes of vomiting. All plans must evidence the involvement and agreement of the resident. The registered provider must ensure that all healthcare needs are identified and addressed including oral health and nutritional assessments where needed. This is an outstanding requirement from 1/4/07. Medication self-administration must be risk assessed to help ensure residents receive any help they need to manage their medicine safely. Timescale for action 02/07/07 2. OP8 12 (1) (a) 02/07/07 3. OP9 13(2) 18/06/07 Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 29 4. OP9 13(2) 5. OP12 12 (2) (3) 6. OP18 17 (2)sch 4 (9) (a) (b) 7. OP19 23 (2) (b) 8. OP24 23 (2) (b) (c) (d) 9. OP26 13 (3) When medication is administered to people who use the service it must be clearly and accurately recorded, to help ensure people receive the correct medication at the right times. (Not met from 27/03/07) When new medicines are prescribed they must be recorded to help ensure they are administered and not missed. The registered provider must ensure that residents who do not smoke have a smoke free lounge area. The registered provider must also ensure the service provides suitable activities for residents. This is an outstanding requirement from 1/5/07. The registered provider must ensure that residents are protected from financial abuse by providing a record of all monies/valuables held for residents. This is an outstanding requirement from 1/04/07 The registered provider must ensure that the planned improvement programme continues and includes the gardens and grounds for residents use. The registered provider must ensure that the home is decorated and furnished to a high standard and that residents are provided with a lockable facility in their rooms and keys to their bedroom doors where agreed. (This timescale is still in date) The registered provider must ensure that care staff that help in the kitchen are provided with a change of uniform to prevent cross contamination. DS0000067128.V335481.R01.S.doc 18/06/07 02/07/07 18/06/07 03/12/07 01/07/07 02/07/07 Abbegale Lodge Version 5.2 Page 30 10. OP29 19 (1) (b) (c) 11. OP30 18 (1) (c) (i) 12. OP38 23 (4) (d) (e) The registered provider must ensure that all pre employment checks are in place prior to any new staff being appointed including current CRB’s and POVA checks. This is an outstanding requirement from 1/4/07. The registered provider must ensure that new staff receives a full induction including all mandatory training. This is an outstanding requirement form 1/4/07. The registered provider must ensure that the registered manager attend annual fire training. 18/06/07 02/07/07 18/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Consideration should be given to carrying out a written audit of medication to enable the manager to more easily see where improvements have been made and where more work may be needed. The inspector recommends that residents should be canvassed for their views with regards to what type of activities they would like. The inspector recommends that residents who wish to follow their religious preferences should be supported. The inspector recommends that complaints should be recorded on a more suitable document. The record should contain full information received including a record of the investigation, dates, statements and signatures and outcomes addressed. DS0000067128.V335481.R01.S.doc Version 5.2 Page 31 2. 3. 4. OP12 OP12 OP16 Abbegale Lodge 5. 5. OP27 OP30 The inspector recommends that staffing levels should be kept under review in particular with regard to residents being able to participate in activities. The inspector recommends that the service should provide training for staff on equality and diversity. Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 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 © 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 Abbegale Lodge DS0000067128.V335481.R01.S.doc Version 5.2 Page 33 - 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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