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Inspection on 02/06/10 for Abbegale Lodge

Also see our care home review for Abbegale Lodge for more information

This inspection was carried out on 2nd June 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

We had made two requirements around how people are first admitted to the home and the sort of information they receive so that they can make a more informed choice. There is now a guide to the home called the `Service User Guide`. This gives up to date information about Abbegale Lodge and the service provided. A copy is kept in the entrance hallway to the main building. We also looked at the contracts and terms and conditions of residency in the home, as these had not been available to people on the last inspection. We checked the files of some of the residents and found that contracts had been made available. They were dated and signed by residents or their representatives.Both of these requirements have been met. We looked at how the health and personal care of people is now managed. This had been of particular concern on the previous visit when we found people who had falls and needs around nutrition and skin care were not being fully supported. We reviewed four people in some depth by looking at care records, observing care and speaking to the residents concerned [where possible]. We found the overall care to be more comprehensive. For example, one person who had needs around pressure care was very well monitored and there had been appropriate liaison with health care professionals, such as the GP and district nurse. Another person had needs around disturbed behaviour due to mental health issues. These were well documented and staff were knowledgeable about their care needs. They were able to tell us about progress to date and how the person was supported on a daily basis. The care records reflected this and we were able to see how health care professionals from outside the home had been involved. Another person with diabetes was receiving ongoing support and needs round diet and nutrition were being carefully monitored. The terms of the Statutory Notice and the requirements made around health care have therefore been met. We Will not be currently pursuing further enforcement action. We looked at medicines administration. Where people chose to look after or administer their own medication this was now recorded within their care plan, to help ensure they receive any support they may need to do so safely. And, since our previous visit further staff have completed certificated medication training allowing greater flexibility in the times that medicines are administered. We asked about how people`s privacy was respected and managed as this reflects on their dignity and overall well being. Staff told us that all residents now receive medical examination in their own bedrooms. We saw that people were appropriately dressed and had appropriate standards of hygiene. One person told us that they could get a shower or bath when needed. This shows a more individualised approach to care. Overall we found care to be better managed and safe and the terms of the Statutory Notice and the requirements made have been met. We will not be taking further enforcement action We looked at peoples social life in the home with reference to the two requirements made around provision of meaningful activities and also the quality and choice of food. We spent some time in one part of the home [the `Flats] where we looked at care files and also spent time socialising with residents. Care files have a social activity sheet, which records people`s preferences in term of activity and past times. Although these were very generalised we were able to see through the reviews that activities are being developed. One person spoke about trips to the shops on a regular basis and this was also recorded in the care file. Another person said, ` the activities [the carer] does are quite enjoyable`. This person particularly enjoyed the quizzes. The day area was relaxed and there was good interactions with care staff who were easily accessible. We looked at photos and residents joined in conversation. We spoke with a carer who now is responsible for organising activities in house [ 2 hours during the afternoon]. There was a programme posted on the wall. These improvements are important to improve the overall quality oflife for people. We can see that social activities are being developed and as such we are satisfied that this requirement has been met. At the last inspection we made seven [7 ] requirements concerning the environmental conditions in the home. We also made a further 5 immediate requirements, which had to be attended to urgently to ensure safety for people living in the home. We checked that these had been met. We saw that the laundry has been developed to ensure separate areas for clean and dirty linen and that hand wash facilities are available to ensure good hygiene. The owner told us that a `housekeeper` will be employed and meanwhile we recommended that a designated care staff should attend to laundry duties on a daily basis. This would help to reduce the risk of cross infection. We saw that some bedrooms [including those specified previously] have been decorated. There is a programme in place to ensure radiators are covered to protect people from burns and likewise the risk of scalds has been addressed by the provision of thermostatic valves to designated hot water outlets. Staff are also monitoring temperatures. We were shown an environmental health officer report from a recent visit that described kitchen standards as `excellent`. Overall we saw enough evidence to judge the requirements made as being met. We reviewed four [4] requirements under the heading of `management and administration`. We spoke wit the manager, Brenda Baily, in some depth, as she assisted us with the inspection. Overall we found her to be more knowledgeable and up to date with the needs of the people living in the home. She showed she has liaised well with the owner to ensure there are improved monitoring and auditing systems in the home to support her in managing Abbegale Lodge. For example, there are now regular audits carried out by a management consultant, as well as regular health and safety audits being conducted by an external agency. These ensure better monitoring of the home and safer standards. The manager was also able to provide an ongoing plan to further develop the home. We are satisfied that the requirements made have been met.

What the care home could do better:

The manager reported that current residents do not have a personal copy of the Service User Guide. We would recommend that this is actioned, so that they have a readily available reference guide to the home. We looked at shared bedrooms. One bedroom had a portable screen now in place to support peoples privacy. Other shared bedrooms are currently empty and the manager reported that screens would be supplied. We had some discussion around the suitability of portable screens, which are cumbersome and difficult for elderly people to move without assistance. We would strongly recommend that curtains with ceiling tracks are supplied, so that people can access and use them individually as needed. This helps people to be more independent. This requirement has therefore been left, as it is not fully met and will be further reviewed at the time of the next inspection.We spoke with the manager about the developments around care planning and how care is recorded. We found some of the language used to be unnecessarily technical. For example `has depression` listed as a care need, and has `illusions`. These are quite wide terms with respect to any possible meaning. We discussed the important of explaining how `depression` affects the persons daily life and how describing this would make the care records more personalised. It would also be more meaningful especially when discussing them with the person concerned. Further improvement is needed in the handling of medication at the home. When we reviewed medicines we were concerned to find that on occasion records showed that where doses of the same medicines were repeated throughout the day, they were given too closely together. This needs to be addressed to ensure people receive the most benefit from their medication. We checked a sample of medicines stocks against the records and looked at care plans to make sure there was enough information to help give medicines safely. We found that with the exception of an occasional discrepancy we were able to account for (track) the handling of medicines in the home. However, we found a lack of individual supporting information about the use of medicines prescribed `when required`. This needs to be addressed to ensure consistency in their use, when needed and to help ensure that their use and effect can be monitored. A new system had been introduced to improve the handling and recording external preparations e.g. creams. We saw that there was supporting information about the use of prescribed external preparations within people`s care plans and that stocks were safely stored. But, there were some `gaps` in the record keeping. The manager needs to continue to audit the record keeping helping ensure that these changes are embedded. We looked at the arrangements in place for checking and handling people`s medicines when they return to the home following a stay in hospital. It was of concern that for one person, changes made to their medicines whilst in hospital had not been noted on their return to the home, instead staff had continued to administer their previous medication. Once this was identified immediate action was taken by the manager to confirm their current medicines and instructions but the homes procedures for checking medicines on admission or re-admission to the home need to be reviewed, to look at how the risk of mistakes can be reduced. We saw that staff are working towards organising more activities for people and we would recommend further training for the staff responsible to support her in this role. We discussed the need to continue to monitor and improve environmental conditions - for example the `finish` to some areas needs more attention, such as the fitting of carpets and hanging of curtains, so that people can experience higher standards of decor and homeliness. We looked at overall staffing levels on the day of the visit as a previous requirement had specified these are reviewed to ensure enough staff to meet the needs of people with some consistency. The manager and owner advised us of imminent plans to employ both a housekeeper and maintenance person, but as yet these have not arrived. There has been no further increase to care staff levels, particularly in the main house although the dependency of care as described by the manager can fluctuate and be quiet high at times. On this visit we found care generally improved and we have not been able to say we have enough evidence that there are sufficient staff to ensure consistent standardsand we have therefore made the judgment that this requirement has not been fully met. This will need further review. We looked at the way the home now manages people`s personal allowances and found these to be correctly maintained. Records seen were up to date. We discussed the need to ensure they are also audited by the owner, as part of his statutory monthly visits and reports on the home. We would further recommend that a policy and procedure is drawn up and is available fo

Random inspection report Care homes for older people Name: Address: Abbegale Lodge 9-11 Merton Road Bootle Liverpool Merseyside L20 3BG zero star poor service 06/10/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michael Perry Date: 0 2 0 6 2 0 1 0 Information about the care home Name of care home: Address: Abbegale Lodge 9-11 Merton Road Bootle Liverpool Merseyside L20 3BG 01519223124 Telephone number: Fax number: Email address: Provider web address: brenda.bailey@blueyonder.co.uk Name of registered provider(s): Name of registered manager (if applicable) Miss Brenda Bailey Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Ramesh Chander Parkash Sabberwal care home 41 Number of places (if applicable): Under 65 Over 65 41 old age, not falling within any other category Conditions of registration: 0 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. One named service user under pensionable age Ramp access to be provided to the home within six months of registration. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Care Homes for Older People 0 6 1 0 2 0 0 9 Page 2 of 12 Brief description of the care home 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 is the registered provider. 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 ramp access is 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 ground floor area. A large rear garden and off street parking is available to the front of the premises. Weekly fees are £383. Care Homes for Older People Page 3 of 12 What we found: We conducted a Key or main inspection of the home on 19th march 2010. We assessed the quality of care in the home as poor at that time and issued 20 requirements to improve the service. We also issued a Statutory Requirement Notice to improve the way care is managed, in particular the health care of people. The date for compliance was 1st May 2010. For this inspection, carried out on 2nd June 2010, we visited unannounced to check specifically whether the terms of the notice and the statutory requirements made have been met. During the visit we spoke with residents and staff including the manager and the provider [owner] who was visiting the home. We also looked at various records including care records and health and safety records, as well as records of residents personal allowances, which were being managed by the home. Overall we found that the terms of the Statutory Requirement Notice had been met and all but two of the requirements made on the last report had also been addressed. As part of this visit we carried out a medicines inspection on the 10th June 2010 to look at the action taken to improve medicines handling in order to address concerns identified at our previous visits and to meet with current requirements. We looked at care documentation within the home and the medication systems that were in place. We spoke with manager and staff responsible for medicines handling. Overall we found that action was being taken to bring about improvement in medicines handling but there were areas that remain to be addressed, to help ensure peoples health and well-being is best protected. Under the heading what the service does well [below] we have listed the requirements that have been met and the supporting evidence for this. Under what the service could do better we have listed the outstanding requirements still to be fully met as well as further good practice recommendations. What the care home does well: We had made two requirements around how people are first admitted to the home and the sort of information they receive so that they can make a more informed choice. There is now a guide to the home called the Service User Guide. This gives up to date information about Abbegale Lodge and the service provided. A copy is kept in the entrance hallway to the main building. We also looked at the contracts and terms and conditions of residency in the home, as these had not been available to people on the last inspection. We checked the files of some of the residents and found that contracts had been made available. They were dated and signed by residents or their representatives. Care Homes for Older People Page 4 of 12 Both of these requirements have been met. We looked at how the health and personal care of people is now managed. This had been of particular concern on the previous visit when we found people who had falls and needs around nutrition and skin care were not being fully supported. We reviewed four people in some depth by looking at care records, observing care and speaking to the residents concerned [where possible]. We found the overall care to be more comprehensive. For example, one person who had needs around pressure care was very well monitored and there had been appropriate liaison with health care professionals, such as the GP and district nurse. Another person had needs around disturbed behaviour due to mental health issues. These were well documented and staff were knowledgeable about their care needs. They were able to tell us about progress to date and how the person was supported on a daily basis. The care records reflected this and we were able to see how health care professionals from outside the home had been involved. Another person with diabetes was receiving ongoing support and needs round diet and nutrition were being carefully monitored. The terms of the Statutory Notice and the requirements made around health care have therefore been met. We Will not be currently pursuing further enforcement action. We looked at medicines administration. Where people chose to look after or administer their own medication this was now recorded within their care plan, to help ensure they receive any support they may need to do so safely. And, since our previous visit further staff have completed certificated medication training allowing greater flexibility in the times that medicines are administered. We asked about how peoples privacy was respected and managed as this reflects on their dignity and overall well being. Staff told us that all residents now receive medical examination in their own bedrooms. We saw that people were appropriately dressed and had appropriate standards of hygiene. One person told us that they could get a shower or bath when needed. This shows a more individualised approach to care. Overall we found care to be better managed and safe and the terms of the Statutory Notice and the requirements made have been met. We will not be taking further enforcement action We looked at peoples social life in the home with reference to the two requirements made around provision of meaningful activities and also the quality and choice of food. We spent some time in one part of the home [the Flats] where we looked at care files and also spent time socialising with residents. Care files have a social activity sheet, which records peoples preferences in term of activity and past times. Although these were very generalised we were able to see through the reviews that activities are being developed. One person spoke about trips to the shops on a regular basis and this was also recorded in the care file. Another person said, the activities [the carer] does are quite enjoyable. This person particularly enjoyed the quizzes. The day area was relaxed and there was good interactions with care staff who were easily accessible. We looked at photos and residents joined in conversation. We spoke with a carer who now is responsible for organising activities in house [ 2 hours during the afternoon]. There was a programme posted on the wall. These improvements are important to improve the overall quality of Care Homes for Older People Page 5 of 12 life for people. We can see that social activities are being developed and as such we are satisfied that this requirement has been met. At the last inspection we made seven [7 ] requirements concerning the environmental conditions in the home. We also made a further 5 immediate requirements, which had to be attended to urgently to ensure safety for people living in the home. We checked that these had been met. We saw that the laundry has been developed to ensure separate areas for clean and dirty linen and that hand wash facilities are available to ensure good hygiene. The owner told us that a housekeeper will be employed and meanwhile we recommended that a designated care staff should attend to laundry duties on a daily basis. This would help to reduce the risk of cross infection. We saw that some bedrooms [including those specified previously] have been decorated. There is a programme in place to ensure radiators are covered to protect people from burns and likewise the risk of scalds has been addressed by the provision of thermostatic valves to designated hot water outlets. Staff are also monitoring temperatures. We were shown an environmental health officer report from a recent visit that described kitchen standards as excellent. Overall we saw enough evidence to judge the requirements made as being met. We reviewed four [4] requirements under the heading of management and administration. We spoke wit the manager, Brenda Baily, in some depth, as she assisted us with the inspection. Overall we found her to be more knowledgeable and up to date with the needs of the people living in the home. She showed she has liaised well with the owner to ensure there are improved monitoring and auditing systems in the home to support her in managing Abbegale Lodge. For example, there are now regular audits carried out by a management consultant, as well as regular health and safety audits being conducted by an external agency. These ensure better monitoring of the home and safer standards. The manager was also able to provide an ongoing plan to further develop the home. We are satisfied that the requirements made have been met. What they could do better: The manager reported that current residents do not have a personal copy of the Service User Guide. We would recommend that this is actioned, so that they have a readily available reference guide to the home. We looked at shared bedrooms. One bedroom had a portable screen now in place to support peoples privacy. Other shared bedrooms are currently empty and the manager reported that screens would be supplied. We had some discussion around the suitability of portable screens, which are cumbersome and difficult for elderly people to move without assistance. We would strongly recommend that curtains with ceiling tracks are supplied, so that people can access and use them individually as needed. This helps people to be more independent. This requirement has therefore been left, as it is not fully met and will be further reviewed at the time of the next inspection. Care Homes for Older People Page 6 of 12 We spoke with the manager about the developments around care planning and how care is recorded. We found some of the language used to be unnecessarily technical. For example has depression listed as a care need, and has illusions. These are quite wide terms with respect to any possible meaning. We discussed the important of explaining how depression affects the persons daily life and how describing this would make the care records more personalised. It would also be more meaningful especially when discussing them with the person concerned. Further improvement is needed in the handling of medication at the home. When we reviewed medicines we were concerned to find that on occasion records showed that where doses of the same medicines were repeated throughout the day, they were given too closely together. This needs to be addressed to ensure people receive the most benefit from their medication. We checked a sample of medicines stocks against the records and looked at care plans to make sure there was enough information to help give medicines safely. We found that with the exception of an occasional discrepancy we were able to account for (track) the handling of medicines in the home. However, we found a lack of individual supporting information about the use of medicines prescribed when required. This needs to be addressed to ensure consistency in their use, when needed and to help ensure that their use and effect can be monitored. A new system had been introduced to improve the handling and recording external preparations e.g. creams. We saw that there was supporting information about the use of prescribed external preparations within peoples care plans and that stocks were safely stored. But, there were some gaps in the record keeping. The manager needs to continue to audit the record keeping helping ensure that these changes are embedded. We looked at the arrangements in place for checking and handling peoples medicines when they return to the home following a stay in hospital. It was of concern that for one person, changes made to their medicines whilst in hospital had not been noted on their return to the home, instead staff had continued to administer their previous medication. Once this was identified immediate action was taken by the manager to confirm their current medicines and instructions but the homes procedures for checking medicines on admission or re-admission to the home need to be reviewed, to look at how the risk of mistakes can be reduced. We saw that staff are working towards organising more activities for people and we would recommend further training for the staff responsible to support her in this role. We discussed the need to continue to monitor and improve environmental conditions - for example the finish to some areas needs more attention, such as the fitting of carpets and hanging of curtains, so that people can experience higher standards of decor and homeliness. We looked at overall staffing levels on the day of the visit as a previous requirement had specified these are reviewed to ensure enough staff to meet the needs of people with some consistency. The manager and owner advised us of imminent plans to employ both a housekeeper and maintenance person, but as yet these have not arrived. There has been no further increase to care staff levels, particularly in the main house although the dependency of care as described by the manager can fluctuate and be quiet high at times. On this visit we found care generally improved and we have not been able to say we have enough evidence that there are sufficient staff to ensure consistent standards Care Homes for Older People Page 7 of 12 and we have therefore made the judgment that this requirement has not been fully met. This will need further review. We looked at the way the home now manages peoples personal allowances and found these to be correctly maintained. Records seen were up to date. We discussed the need to ensure they are also audited by the owner, as part of his statutory monthly visits and reports on the home. We would further recommend that a policy and procedure is drawn up and is available for reference regarding ongoing practice. Also that excess amounts of moneys are banked for individuals to reduce any risk of excess monies being kept on the premises. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 24 12 Appropriate screens must be 01/06/2010 made available in all shared rooms. This will help ensure a degree of privacy. 2 27 18 The provider and manager 01/06/2010 must review the overall staffing in the home and ensure that there is sufficient numbers of both care and ancillary staff cover on duty. This is to provide a consistent level of care. Care Homes for Older People Page 9 of 12 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, 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 Medication must be safely administered as prescribed -procedures for handling medicines on admission or re-admission to the home need to be reviewed to reduce the risk of mistakes - care needs to be taken to maintain adequate dose intervals between doses of the same medicine to help ensure peoples health and well-being is best protected. 12/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The manager reported that current residents do not have a personal copy of the Service User Guide. We would recommend that this is actioned, so that they have a readily available reference guide to the home. The need for to assess peoples mental capacity at the point of admission to the home should be incorporated in Page 10 of 12 2 3 Care Homes for Older People 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 the admission and ongoing assessment process. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. 3 4 7 12 Peoples care plans should be made more personalised, with reference to comments made in this report. We saw that staff are working towards organising more activities for people. We would recommend further training for the staff responsible to support this role. The manager and all staff need to be updated regarding the mental capacity act 2005 and the Deprivation of Liberty safeguards and incorporate assessments into current documentation. We discussed the need to continue to monitor and improve environmental conditions - for example the finish to some areas needs more attention, such as the fitting of carpets and hanging of curtains. This helps to ensure people can experience higher standards of decor and homeliness. We discussed the need to ensure residents finances are audited by the owner, as part of his statutory monthly visits and reports on the home. We would further recommend that a policy and procedure is drawn up and is available for reference regarding ongoing financial practices for monies held on behalf of the residents. Also that excess amounts of moneys are banked for individuals to reduce any risk of excess moneys being kept on the premises. 5 18 6 19 7 35 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - 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. 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