Inspection on 07/02/07 for Abbegale Lodge

This inspection was carried out on 7th February 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 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

Abbegale Lodge 02/06/10

Abbegale Lodge 18/03/10

Abbegale Lodge 06/10/09

Abbegale Lodge 17/06/08

Abbegale Lodge 15/05/07

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 Key Unannounced Inspection 7th February 2007 09:20 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.V324525.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.V324525.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 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) 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.V324525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. This is a new service as new registered provider. Date of last inspection 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 home is situated on a busy road close to bus services and a train station. It is within easy distance of local amenities. The home is set out as two converted Victorian villas with a two story modern extension. There is lift access to the main building with a stair lift in place to one of the villas. The home has a call bell facility in residents’ rooms and public areas. The home 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 home. Weekly fees are £355.50 Abbegale Lodge DS0000067128.V324525.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 approximately 7 hours. For the process of inspection two inspectors were present. The home has recently changed ownership in September 2006 and Mr Sabberwal is now the registered provider. Miss Bailey continues to be the registered manager. As the home is now in new ownership this inspection is the first key inspection. As part of the inspection process all areas of the home were viewed including most of the residents bedrooms. Residents care records and other care home records were inspected also. Discussion took place with Mr Sabberwal and Miss Bailey. The inspectors also had discussions with 2 care staff and several residents, eight of which were on a one to one basis. Residents’ views on how the home was run were gained during these interviews. Concerns have been raised with regard to a resident therefore this has been investigated during the visit. What the service does well: During resident interviews many gave positive feedback about how they live their lives with comments such as, “I have no complaints and am very happy, it’s homely and staff are very good”. Residents interviewed confirmed that staff treated them courteously and with kindness. Some of the residents interviewed were keen to have some friendly banter with the staff and enjoyed the friendly chats The home accesses a District Nurse to provide healthcare for one of the residents and the resident confirmed this stating, “the District Nurse visits every Friday and the treatment is good”. Residents interviewed stated, “I have a good diabetic diet, the food is excellent and staff give me my medicines and I see my GP about my medicines”. Other residents interviewed stated, “there is a choice at mealtimes, and Elaine (cook) does home baking and “every day the food is good”. Other residents interviewed confirmed that the food served in the home is good and fresh fruit and vegetables were served on a regular basis. The home have an open visiting policy and residents interviewed confirmed this, stating, “our two sons visit anytime”. Residents were canvassed for their views with regard to the change of ownership with one resident stating, “we miss the family feeling in the home”. Other residents interviewed were much more positive about the change of ownership and confirmed that they had met the new owner and were looking forward to the improvements that were to be in place soon. Residents Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 6 confirmed that they had a meeting to discuss the planned decoration and improvements. One resident stated, “I’m not worried, I’ve met the new owner and he is kind, we are to have a chair lift fitted to the staircase this month, new furniture and roller blinds fitted to the lounge windows, which will keep it cooler in the summer”. Residents interviewed about their routines stated “we can get up and go to bed when we want” and confirmed that a female carer provides support and assistance with personal care. What has improved since the last inspection? What they could do better: The assessment process still needs to be improved to ensure that all the residents’ needs including healthcare are identified otherwise residents care will be compromised. Residents are placed at risk as care needs are not fully identified and care plans do not reflect regular reviews of care. One resident had no care plan. The manager needs to audit all care documentation so that areas that need improving are addressed as a matter of priority. Poor management and administration of medication places residents at risk. An urgent review of how the medication in the home is managed is needed. The inspectors have arranged for the Commissions pharmacist to inspect the home. Some of the residents interviewed were not happy that other residents smoked throughout the public areas of the home and would prefer a non-smoking area. At present residents were also concerned about the lack of activities at Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 7 present. Residents’ interviewee stated, “there are no staff to help with activities”. One resident is at risk of financial abuse due to inadequate management of financial records. Therefore it is necessary for full financial documentation to be in place for this resident. The residents advocate needs to be aware that the home needs to keep records to protect the resident. The home need to provide an individual lockable facility in each residents bedroom and residents who wish to have keys to their bedrooms following completed risk assessments. Residents are at risk of their concerns/complaints not being addressed through the complaints procedure. At present the home do not record concerns/complaints that are raised therefore it is imperative that all concerns/complaints are recorded and fully investigated. The outcomes are to be given to the complainant and on record also. Residents are at risk of isolation as wheelchair access is not available throughout the home. The provider advised the inspectors that an assessment of the premises is to be requested from a suitably qualified person so that any recommendations made are taken into account during the planned upgrading of the home. Although the provider has planned and booked part of the upgrade to the home, the inspectors advised that the home needs to have a full audit carried out to ensure residents bedrooms, public areas that need decoration, repair/replacement of furniture are identified and an effective maintenance programme is in place. Residents and staff are placed at risk due to out of date/absent mandatory training and inadequate pre employment checks. This needs to be addressed as a matter of urgency. The manager also needs to monitor staffing levels to ensure that residents care is not compromised as there have been some occasions when the ‘flats’ area of the home are short. 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.V324525.R01.S.doc Version 5.2 Page 8 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.V324525.R01.S.doc Version 5.2 Page 9 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 adequate. The assessment process still needs to be improved to ensure that all the residents’ needs including healthcare are identified otherwise residents care will be compromised. This judgement has been made using available evidence including a visit to this service. OP 3 was assessed. OP6 is not applicable. EVIDENCE: Three of the residents were case tracked (all care documentation including care plans are examined) during this inspection and an additional two residents assessment documentation was examined. The assessment process still needs to be improved as not enough information is collated to ensure that the residents’ needs are fully identified. A formal record of the assessment process needs to be in place as this will help to ensure all areas have been looked at. Previous medical history, medication, communication, incontinence, risk of falls, sleep pattern, personal hygiene, limited mobility is identified in Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 10 one residents assessment notes but with the other resident there is a lack of information. There is no reference to many areas including personal care, continence, sleep pattern and mobility. There is also no reference to either of the residents needs in areas including diet, eyesight, oral care, chiropody and hearing. Two of the residents’ religious needs are not identified. For one resident, there is no family/friend contact details/telephone numbers in place despite having a husband and been resident for four years. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 11 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 poor. Residents are placed at risk as care needs are not fully identified and care plans do not reflect regular reviews of care. Poor management and administration of medication places residents at risk. This judgement has been made using available evidence including a visit to this service. OP7,8,9,10 were assessed. EVIDENCE: One resident has no care plan. Another resident has a care plan in place addressing poor mobility and poor appetite but not the other healthcare needs that the resident has. In particular one resident has mental health needs and has some input from the CPN (Community Psychiatric Nurse) but this is not addressed in the care plan. This resident has also had a period of regular daily entries stating, “deliberately puts herself on the floor”. This had not been addressed either. The last monthly review of care is documented as February 2006. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 12 Some of the care plans lack information with regard to the amount of support and assistance residents may need to meet their individual needs. Manual handling assessments are in place for two residents but reviews are very irregular with one resident not reviewed for almost a year. Norton scores (tool for measuring risk of developing pressure sores) have been carried out for one of the residents in January 2006 but not since and the other two residents have not had one. The manager stated that “some of the residents have attended the optician”, but the documented evidence is not recorded in residents care documentation. It is kept separately therefore this needs addressing so that records show clearly who has had optical input and who needs it with dates included. There is no evidence that residents have had any dental input therefore this needs addressing to ensure residents teeth and oral health is assessed and kept under review. Badly fitting dentures may cause problems with diet intake or gums therefore it is important that residents oral hygiene is attended to daily especially following mealtimes to ensure foodstuffs are not still in situ. Care documentation does not evidence any dental input. The home need to ensure that all needs are assessed and identified with management of how the individual residents needs are to be met recorded in the care plans. Instructions with regard to mouth care, spectacles, eye care (where necessary), hearing aids need to be recorded in care plans and reviewed on a regular basis to ensure the information is up to date and consistent with the required needs of the individual resident. Residents interviewed confirmed that the GP and District Nurse visit the home regularly. One resident interviewed stated, “the District Nurse visits every Friday and the treatment is good”. One of the residents interviewed confirmed that the chiropodist had visited the home during the inspection. Another resident interviewed stated, “my new glasses arrived today and they are being fitted by the optician”. These visits are recorded in residents care files. During the visit it was noted that one of the residents who was transferred by wheelchair had no footrests in position, therefore they were at risk of injury. There are no nutritional assessments in place and weights are not evidenced in all care documentation. One resident stated, “I have a good diabetic diet, the food is excellent and staff give me my medicines and I see my GP about my medicines”. One resident is identified in their documentation that they are self-medicating with regards to medications. There is no risk assessment in place to ensure that the resident is able to. Following discussion with the resident they confirmed that they no longer self medicate. This should be documented. The medication returns book was viewed and evidences some medication returns to the pharmacy with the pharmacy signature in place. Medication sheets were viewed and evidences scribbled out errors. The home is advised to put only one line through the error and record an explanation. Atrovastin and isosorbide mononitrate are missing signatures on several days. Most of the residents’ medication is administered from ‘blister packs’. On some of these packs there is no continuity of removal of medication with some tablets removed at random. This is confusing when carrying out an audit of the Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 13 medication. It also means that it is difficult to know if residents are receiving their prescribed medication. The medicine trolley and cabinets are unlocked. Various medications were lying around the room including medication without labels to identify which resident the medicine was prescribed for. Flucloxacillin 250mg x7 described as ‘bag stock’ dated 12/5/06 was in stock and the manager was unable to account for this. Aricept 15mg and Losec 20mg did not have resident’s names on the labels. Paracetamol was in evidence also without a label to identify if they were for resident use. There is no record of homely medicines. This was raised at the previous inspection. Six other residents prescribed medication were ‘lying’ around the desk also. One resident who had passed away on 5th January 2007 Oramorph medication was in the open drug trolley with other medication on the desk also. Three prescribed creams were found in the ground floor toilets, this is poor practice. Discussion took place with the manager regarding the above issues. One resident who self-administers Metformin at lunchtime has no risk assessment in place therefore this needs addressing. Other residents prescribed Lanzaprazole, Frusemide, Bendrofluazide have many missing signatures therefore it is assumed they did not receive their prescribed medication, which is of serious concern. One resident who is prescribed Warfarin has unclear records and missing signatures also. The manager was advised that the Commissions pharmacist would be requested to visit the home, as clearly there are serious issues with regard to the management of medication. Regular audits need to be carried out to ensure that medication is administered to the residents as prescribed and that all other medication is stored securely with procedures and documentation clear for staff who administer the medication. All staff that administers the medication needs to have training and following this the manager needs to assess the individual staff to ensure competency before being responsible for the role. Residents interviewed confirmed that staff treated them courteously and with kindness. Some of the residents interviewed were keen to have some friendly banter with the staff and enjoyed the friendly chats. Discussion took place with the manager with regard to residents having more privacy and having the facility to lock their bedroom doors. This needs to be addressed. Residents interviewed confirmed that staff knock on their bedroom doors prior to entry. Abbegale Lodge DS0000067128.V324525.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 good. Residents gave positive feedback about how they live their lives although some expressed concern about the lack of activities. This judgement has been made using available evidence including a visit to this service. OP12,13,14,15 were assessed. EVIDENCE: Residents do not have keys to their bedroom doors and this is being addressed shortly as one resident in particular would like to use this facility. Concerns had been raised by the advocate of a resident regarding another resident wandering into their bedroom therefore this needs addressing. The inspectors discussed risk assessments with regards to residents holding their own keys with the manager and the provider. Smoking is in place throughout the homes public areas, which some of the residents are not happy with. Residents interviewed stated, “it’s smoky in the lounge and some of the staff smoke in here also”. One resident was observed to be smoking in their bedroom. The manager was advised to carry out a risk assessment to ensure residents are not placed at risk. For residents who do Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 15 not wish to smoke there is no smoke free area for them other than their bedrooms. Therefore this needs addressing. Questionnaires sent out to residents highlighted that many were not happy with the activity programme with comments received such as, “poor activities in house”, “no activities” and “some activities and outings please”. Residents interviewed stated, “there are no staff to help with activities”. The new programme of activities is listed and displayed on residents notice boards and includes Valentine Day entertainment with buffet, Art, musical entertainer booked for St Patrick’s Day and trips out booked in an adapted taxi with staff volunteering. Two staff is responsible for the arrangements. Residents interviewed confirmed that the hairdresser visits each Monday. Residents interviewed stated, “I go out to church and have Holy Communion here”. Residents interviewed stated, “we go out most days and visit the Strand”. Residents interviewed stated, “our two sons visit anytime” and “other residents interviewed confirmed that relatives and friends can visit the home at any time”. One resident interviewed stated, “I have no complaints and am very happy, it’s homely and staff are very good”. One or two of the residents interviewed felt unsure about the homes future since the ownership of the home had changed recently and stated, “we miss the family feeling in the home”. The provider and manager were advised of this and are to address it. Other residents interviewed were positive about the change of ownership and stated, “I’m not worried, I’ve met the new owner and he is kind, we are to have a chair lift fitted to the staircase this month, new furniture and roller blinds fitted to the lounge windows, which will keep it cooler in the summer”. Residents interviewed stated, “we can go to bed when we want”. One resident interviewed stated, “I do not want to share my bedroom, I would like a new bedroom, I would like to stay in the same block”. During further conversation the resident confirmed that he had been offered a single room in the ‘flats’ but was reluctant to move there as he preferred the ‘block’ that he was in. He also wished to move out and live on his own therefore with his permission this discussion was related to the manager so that his social worker could be contacted and a review of his care needs take place. Residents interviewed stated, “ there is a choice at mealtimes, and Elaine (cook) does home baking and “every day the food is good”. Other residents interviewed confirmed that the food served in the home is good and fresh fruit and vegetables were served on a regular basis. A four weekly menu is in place. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 16 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. Residents are at risk of financial abuse due to inadequate management of financial records. Residents are at risk of their concerns/complaints not being addressed through the correct complaints procedure. This judgement has been made using available evidence including a visit to this service. OP16, 18 were assessed. EVIDENCE: An advocate has made an allegation of theft of money on behalf of a resident. Money has gone missing on three occasions. There is no record of this being documented despite the manager being aware of the alleged theft. This resident has a small cash box that is stored in the manager’s office. The manager was advised to lock the box in a secure facility. The residents’ advocate is the only one who now has a key to the box. The inspectors advised that records need to be kept of monies held and transactions made for this resident. Financial records are kept of residents’ monies. Entries are put in for the purchase of items. The manager stated, “the receipts are in the safe”. Receipts for residents’ financial transactions need to be stored in individual residents files. Residents’ monies should be audited by two senior staff on a monthly basis with records kept. Residents do not have a lockable facility in their bedrooms therefore this needs addressing. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 17 The home has a copy of the Sefton Adult Protection Procedure. A complaints procedure is available to residents in a leaflet format. Residents interviewed stated, “I have no complaints” and “I would speak to Brenda (manager) if I wanted to complain”. Any concerns/complaints that are raised in the home need to be documented and a full investigation and outcomes need to be recorded and available for inspectors to view Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 18 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. Residents are at risk of isolation as wheelchair access is not available throughout the home. The home needs to have a full audit carried out to ensure residents bedrooms, public areas that need decoration, repair/replacement of furniture are identified and an effective maintenance programme is in place. This judgement has been made using available evidence including a visit to this service. OP 19,22,24,26 were assessed. EVIDENCE: The new provider and inspector toured the home during the unannounced visit. The provider has identified areas in the home that require upgrading and is to plan a programme of decoration and repair/upgrade whilst prioritising some areas. Many of the bedrooms and public areas require redecorating and furniture in some areas needs refurbishing/replacing. Other items that need Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 19 repair/replacing include, window blinds, curtains missing, rear of wardrobe open and bed lights. The provider had already had some quotations for some of the work that is needed and is also due to provide wheelchair access by providing a ramp to one area of the home to ensure wheelchair access. Plans have been drawn up and the provider is due to make a decision on which ramp would be suitable for the residents. Decorators are due to commence work in the communal areas on the 12th March 2007. Dining tables and chairs are being replaced. The inspector recommended that a qualified person carry out an assessment of the premises to ensure the home is suitable for the residents. Since the inspection visit the inspector has been advised that a Physiotherapist is to visit the home shortly to carry out this assessment. Discussion took place with the manager regarding auditing the building. The home needs to have a full audit carried out annually and be regularly checked throughout the year so that minor repairs/replacements are identified and attended to. A maintenance book needs to be kept that records any repairs/replacement required, the date the repair took place including the signature also. Residents interviewed raised concerns regarding the home being cold on occasions but confirmed it was warm at night, they thought that the heating might be on a timer. The manager was advised of these concerns. Residents interviewed had conflicting reports about the laundry service provided at the home stating, “things get lost and are never found” and “the laundry is good”. One of the residents advocates had raised concerns that their bedroom was smelly and the commode was not being emptied. The bedroom was checked during the visit and was found to be clean and odour free. The manager stated, “this resident is often sick as she eats carry out meals as well as her evening meal, the carpet is shampooed often”. Most of the other bedrooms were checked during the visit and found to be clean and odour free. All of the bedroom commodes were checked and were clean and empty. Some of the residents interviewed are generally pleased with their environment but others particularly in the older parts of the home would like to see some improvements to the décor and furnishings. Residents interviewed stated, “my room is cleaned every day” and “the bedroom is nice and spacious, the furniture is a bit tatty and it needs decorating”. One other resident interviewed stated, “I have a nice bedroom, it’s comfortable” The kitchen was clean and tidy during the visit. Hot food temperatures are recorded. The two smaller freezers have no temperatures recorded and a new thermometer is required for the larger freezer. Care and domestic staff were observed preparing vegetables in the afternoon whilst also caring for residents during toileting and transfers. This can put residents at risk of cross infection therefore this needs addressing. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 20 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. Residents and staff are placed at risk due to out of date/absent mandatory training and inadequate pre employment checks. The manager also needs to monitor staffing levels to ensure that residents’ care is not compromised. This judgement has been made using available evidence including a visit to this service. Op27,28,29,30 were assessed. EVIDENCE: The duty roster was viewed for the week commencing 11th February 2007. It does not evidence the hours worked by the manager therefore this needs addressing. Other staff hours should identify the position in the company and night staff hours should be detailed the same as day hours worked. Six carers are on duty with 2 domestics, a cook and the manager. No new staff has been employed since the last inspection. Mandatory training is out of date. The manager stated that training has been booked including infection control and COSHH (Control of Substances Hazardous to Health) training, which has been arranged for staff to attend this month. Between 5-8 places have been booked for NVQ training in March this year. The manager is also trying to access NVQ training to Level 4 for some of the senior care staff. One staff interviewed confirmed that they had attended infection control training but no other training recently. Another staff Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 21 interviewed confirmed they had received an induction by the previous owner and had attended manual handling training. Staff interviewed advised the inspector that on occasions they can be short of staff for half to one hour, with a senior coming over to help. One staff interviewed stated, “I love the work, it’s great”. Staff interviewed stated, “I like working here staff are friendly, the new owners are polite and friendly and the manager is quite approachable”. Five staff files and training records were examined. References are in place in some of the staff files with some not dated. Most of the staff files only evidence one reference (some undated) with one staff file having no references at all. CRB (Criminal Record Bureau) checks are evidenced at enhanced level. In some staff files a CRB number is recorded but not the date it was returned. Some of the staff files evidence induction. Most of the mandatory training is out of date. There is no evidence of any mandatory training in one staff file. There is some evidence in one or two files with regard to ‘in date’ training including first aid. Staff files evidence application forms, interview notes in some with no date or signature, pre employment questionnaires evidenced, contracts are evidenced, verbal reference request but no date or signatures, and infection control training for one. There is no record of staff supervision and staff interviewed confirmed this. Care and domestic staff in the flats were preparing potatoes in the communal area for tomorrow’s dinner. The vegetable knife was left on the table/kitchen surface whilst one of the care staff took a resident to the toilet. The domestic and carer later ‘drag lifted’ the resident into an armchair. Residents are placed at risk from cross infection, possible injury from the knife and the poor manual handling technique practiced on the resident. The manager was advised of this. Residents interviewed stated, “staff are okay, there are too many chiefs” and “staff are very good, no complaints at all”. Other residents interviewed stated, “staff are kind and prompt, they answer call bells day and night”. One resident interviewed stated, “there are enough staff on at weekends but if there is sickness, the cleaner does care assistant work”. Staff interviewed confirmed that there can be times when they may be short and one carer is left in the ‘flats’. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 22 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 poor. Residents and staff are placed at risk as fire training and maintenance checks are out of date. This judgement has been made using available evidence including a visit to this service. OP31, 33, 35, 38 were assessed. EVIDENCE: The registered manager has been employed for approximately three years. She has gained the RMA in 2006. Training attended by the manager includes COSH October 2006 and the key manual handling training in August 2006. The manager needs to identify the additional training needs that will enable her to manage the home more effectively as many areas have been identified in this report that need addressing. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 23 The manager stated, “a residents meeting has taken place at the end of 2006 with regard to decoration of the home” but no minutes were made. Quality assurance surveys were given out to residents with regard to how the home is run in January 2007 and ten were returned. The manager is to summarise the response. Questionnaires returned gave fair to good feedback about how the home is run. The main concerns raised by the residents in the returned questionnaires are the lack of activities and outings. The manager has planned to send out relatives’ questionnaires this month. Policies and procedures need to be reviewed and include up to date information with regard to physical intervention and pressure relief. Fire training is out of date and urgently needs implementing. A fire drill was carried out in December 2006 (by Colin Thompson Merseyside) and a discussion took place regarding fire training. There is no weekly fire alarm check. The process of this was explained to the manager. The most recent fire check was carried out on 2/2/07. A fire logbook needs to be in place with all fire checks, fire drills and dates on record. A fire risk assessment of the premises needs to be carried out. Gas appliances were checked in May 2006 and the full check including boilers and heating is due on 22nd May 2007. The manager advised that the previous provider carried out all the maintenance checks and none have been done since. The manager has been advised that these checks are to re commence to include hot water checks and bathing water prior to bathing residents with records kept. The electric certificate is not due until February 2010 and the emergency lighting was checked in February 2007. The lift was serviced in February 2007 but no documentation was available to view. A copy of this document evidencing this service needs to be forwarded to the Commission. COSHH (Control of Substances Hazardous to Health) assessments have been carried out and training has been implemented in February this year. The manager stated that, “portable appliances were serviced by the previous owner”, but there is no record/date to view. Secure facilities are not available in residents’ bedrooms therefore this needs addressing. The manager needs to carry out risk assessments for all safe working practices and document this. All staff need to receive induction and foundation training and are updated to ensure safe working practice. Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 24 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 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 2 17 X 18 2 2 X X 1 X 2 X 2 STAFFING Standard No Score 27 2 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 1 Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 (1) (2) Requirement The registered provider must ensure that prospective residents must be appropriately consulted and a qualified person assesses their needs prior to admission. This must be documented. The registered provider must ensure that every resident has a care plan, that it identifies all healthcare needs and regular reviews take place with the involvement and agreement of the resident. The registered provider must ensure that nutritional assessments, residents’ weights, Norton scores are recorded on admission to the home and regular reviews of these are recorded. The registered provider must ensure that all residents have up to date manual handling assessments in place, which are signed, dated and risk assessments must identify residents at risk of falling and how this is managed. The registered provider must DS0000067128.V324525.R01.S.doc Timescale for action 01/04/07 2. OP7 15 (2) (a)(b)(c) (d) 01/04/07 3. OP8 12 (1) (a) 01/04/07 4. OP8 13 (5) 01/04/07 5. OP9 13 (2) 01/04/07 Page 26 Abbegale Lodge Version 5.2 6. OP9 13 (2) 7. OP9 13 (2) 8. OP12 12 (2) (3) 9. OP16 22 (3) (4) 10. OP18 17 (2) sch 4 (9) (a) (b) 23 (2) (b) 11. OP19 12. OP22 23 (2) (a) (n) 23(b) (c) (d) 13. OP24 ensure that all medication received into the home is counted, dated, stored correctly and securely and signed for. Regularly monthly audits must be documented. The registered provider must ensure that all residents who self medicate have a risk assessment completed, which is reviewed and evidenced. The registered provider must ensure that all staff trained and assessed as competent to administer medication sign the medication record immediately following administration. The registered provider must ensure that residents who do not smoke have a smoke free lounge area and much more activities following consultation with the residents. The registered provider must ensure that all concerns/complaints raised are to be fully investigated and residents/complaints made aware of the outcomes. The registered person must ensure that a record is kept of all monies/valuables held for residents. The registered provider must ensure that the home has a planned maintenance programme and records kept including a maintenance book. Hot water records including residents’ bathwater must be tested and recorded prior to bath. The registered provider must ensure that a qualified person carries out an assessment of the premises. The registered provider must ensure that the home is DS0000067128.V324525.R01.S.doc 01/04/07 01/04/07 01/05/07 01/04/07 01/04/07 01/05/07 01/05/07 01/07/07 Page 27 Abbegale Lodge Version 5.2 14. OP26 13 (3) (4) (c) 15. OP27 18 (1) (a) 16. OP29 19 (1) (b) (c) 17. OP30 18 (1) (c) (i) 23 (4) (c) (d) (e) 18. OP38 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. The registered provider must ensure that staff do not put residents safety at risk through cross contamination or injury (whilst peeling vegetables in the residents dining/sitting area) using sharp knives and toileting residents. The registered provider must ensure that the manger keeps under review the staffing levels to ensure residents’ needs are not compromised. The hours that the manager is planning to work must be identified on the duty rota. The registered provider must ensure that all pre employment checks are in place prior to any new staff employment including all staff employed to have current CRB’s. The registered provider must ensure that new staff receives a full induction including all mandatory training. The registered provider must ensure that all staff attends annual fire training with night staff on a more regular basis. The fire alarm must be tested weekly, the fire logbook must evidence all measures carried out with regard to fire safety. A fire risk assessment must be carried out. Portable appliances must be tested annually with records kept. 01/04/07 01/04/07 01/04/07 01/04/07 01/04/07 Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 28 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 OP10 OP18 OP26 OP31 Good Practice Recommendations The inspector recommends that residents who do not wish to share rooms should be given priority and moved to a single room of their choice. The inspector recommends that all receipts with regard to financial transactions should be kept with the individual residents money record. The inspector recommends that a new fridge thermometer should be purchased to replace the broken one. The inspector recommends that the manager should ensure she is up to date with all mandatory and other training/qualifications to ensure she has the qualities needed to manage the home. The inspector recommends that the home further develop the quality assurance systems. 5. OP33 Abbegale Lodge DS0000067128.V324525.R01.S.doc Version 5.2 Page 29 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.V324525.R01.S.doc Version 5.2 Page 30 - 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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