CARE HOMES FOR OLDER PEOPLE
Abbendon Nursing Home 45 Scarisbrick New Road Southport Merseyside PR8 6PE Lead Inspector
Mrs Claire Lee Unannounced Inspection 2nd November 2005 09:30 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 Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Abbendon Nursing Home Address 45 Scarisbrick New Road Southport Merseyside PR8 6PE 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) 01704 538663 01704 884110 Mr Mark J Gilbert Mrs Wendy J Gilbert Miss Valerie Atherton Care Home 24 Category(ies) of Dementia (24) registration, with number of places Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 24 DE Date of last inspection 16th May 2005 Brief Description of the Service: Abbendon is a large detached property that has been converted in to a care home. The home is situated in a residential area of Southport with easy access to the town centre and local amenities. Mr and Mrs Mark Gilbert privately own the home. Mr Gilbert also owns other homes in the area as part of the Dovehaven group. Abbenden provides care for twenty four older people who have enduring mental health needs and who are physically frail. A call system is operational for the residents throughout the home and bathrooms have adapted equipment. The home is situated over four floors and provides fourteen single rooms and five double rooms. A passenger lift provides access to all areas and there are ramps to the main front door. The home has an attractively decorated lounge on the ground floor and conservatory on the first floor. External grounds are well maintained with an enclosed garden at the rear. There is also ample car parking space. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days for a duration of seven hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There has been no cause for any visits to the home since the last routine inspection in May 2005. A tour of the building was conducted. A selection of care, staff and nursing home records were viewed and discussion took place with the manager, administrator and three staff members. Four relatives and three residents were spoken with and their views obtained of the home. Satisfaction comment cards were also left for residents and relatives to complete at their leisure. What the service does well:
The home has a friendly relaxed atmosphere and staff were seen working as an effective team. Residents and relatives spoken with were complimentary regarding the standard of care, which is delivered from hard working and enthusiastic staff. A member of staff who has worked at the home for many years spoke positively regarding the overall management of the home and the good support she received from the manager. The home has an interesting activities programme, which is suited to the residents’ individual needs. Reminiscence therapy is arranged each week and residents are encouraged to participate on the weekly trips out. Last week an excursion was arranged to Blackpool to see the lights and have fish and chips. Relatives are welcome to join in with all the social arrangements. The manager is good at gathering assessment information relating to the residents prior to admission. More often than not relatives and health professionals are consulted as residents are not able to communicate their needs due to the frailty. Assessment documents seen had been completed in detail and emphasis placed on understanding and meeting psychological and behaviour needs. Information obtained is then used to form the basis for the plan of care, which is developed over a period of time by the staff. The care documentation is organised, easy to read and subject to regular review thus ensuring records are up to date. Care staff are prompt to report any problems
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 6 as they arise and care files evidenced hospital appointments and medical referrals at the appropriate time. Any aggressive behaviour from residents is recorded and staff note the cause and most effective treatment. Discussion with staff confirmed their understanding and knowledge of dementia care. It was evident that staff closely monitor those who require a greater level of assistance due to their frailty and changes in behaviour. Residents are able to walk freely round the building as the home has key pad locks on landing doors and the main front door. The home is very safety conscious however restrictions are kept to the minimum. Relatives were complimentary regarding the professional attitude of staff and the good communication that exists. The manager was described as being, “Excellent in all ways”. The home is very well maintained and colour schemes attractive throughout. The home presents as very clean and a relative reported, “This standard of cleanliness is kept at all times”. Resident bedrooms have a good standard of furniture and the bathrooms have suitably adapted equipment. What has improved since the last inspection?
Quantities of medicines received in the building are recorded on the medicine sheets and external preparations are signed for by staff when administered. Records of hot water temperatures are generally maintained to ensure hot water is delivered to safe temperature. New staff receive an induction with the manager and also attend an external study day for this purpose. Staff receive fire awareness training at least twice a year. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 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 Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 (Intermediate Care is not provided at Abbenden) Residents and/or their representative receive contracts following admission to the home. The manager assesses all care needs prior to and during the early stages of admission. This ensures resident care needs can be met. EVIDENCE: A number of resident contracts were viewed and these had been signed and dated by the resident and/or their representative. Admissions to the home can be in the case of an emergency or are generally planned and routine. Individual records are kept for each resident and the manager had completed assessments prior to the resident arriving at the home. Assessments seen were completed to a good standard and information was also available from other health professionals including community psychiatric staff, social workers and the local hospital. Inspection of a recent admission recorded details of general health, mobility, nutrition, social contact,
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 10 psychological and behavioural needs. The information is then collated to form the plan of care. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Residents health, personal, psychological and social care needs are addressed in care plans. Care needs are met effectively thus ensuring a good overall standard of care in the home. Medicines are administered according to the home’s policy and procedure. EVIDENCE: Two care files were viewed, the documentation was easy to read and had been reviewed regularly to ensure information recorded was up to date. Each resident had an individual plan of care that clearly identified key areas such as general health, mobility, risk of falls, nutrition, skin care, social, psychological and behavioural needs. General risk assessments for the use of bed rails, pressure relief/aids and manual handling had also been completed. Dietary needs were being monitored and weights recorded. A record of wound care indicated the current treatment and progress of the affected site. Residents are able to see their own GP and visits by health professionals had been recorded. A relative reported, “The care is also always very good and the staff are very professional.” Relatives interviewed stated that they were kept informed of the plan of care and any changes in treatment.
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 12 Psychological needs are initially assessed prior to admission and then as staff become more familiar with the behaviour patterns of each resident this information is then added to the care plan. The manager and staff place emphasis on communication and spend considerable time getting to know each resident’s personal likes and dislikes, for example, colour, foods, noise, family, sleep pattern and hobbies. Information is often obtained from family members and other health professional as a number of residents are not able to communicate their needs effectively. If a resident is very agitated then these bouts of agitation are monitored carefully by the staff and are recorded in their plan of care with reference to the cause and treatment. A relative said, “My father always looks so well cared for and the staff understand and know exactly what he needs.” A number of medicine sheets were seen and these evidenced staff signatures following administration. The medicine trolley is stored in the clinical room and this is kept locked when not in use. It is recommended that if a medicine is omitted by staff, the correct code be completed as stated on the medicine sheets. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 The daily life and routine in the home is based around the individual needs of the residents. Social interests are well managed and visitors are welcome at any time. EVIDENCE: The home presents with a very relaxed ‘homely’ atmosphere and staff were seen to be very caring and patient when assisting residents with their care. The routine of the day may alter according to individual need and any changes in residents’ behaviour. Staff interviewed were aware of the importance of understanding and dealing with any change that may affect the resident’s well being. Residents were observed spending time chatting with staff in the lounge or taking gentle exercise round the home. Comfortable armchairs are provided throughout if residents wish to take a rest. Visitors were seen popping in at various times and a relative reported, “The staff always offer us a cup of tea and are so welcoming when we arrive.” The home offers an activities programme, which takes into consideration the resident’s physical and psychological needs. An activities organiser visits each
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 14 week and residents take part in music, reminiscence therapy, card games, dancing and games. Manicures and aromatherapy are also provided. The home has a minibus and trips out are arranged each Wednesday. A trip to Blackpool lights was enjoyed last week. Staff accompany the residents and relatives are also welcome to join in. Preferred social interests are stated in the plan of care on admission and are reviewed regularly with relatives. A resident said, “I like all the trips and enjoy the company of the staff.” The home has a large enclosed rear garden, which is enjoyed during the warmer months by the residents. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has a vulnerable adults’ procedure to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: Abuse awareness is discussed during the induction process for all new staff and training is also provided. The home has abuse policies and procedures, local guideline and a whistle blowing policy. A staff member interviewed discussed the concept of abuse with reference to dementia care. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 The home is well maintained and pleasantly decorated thus providing comfortable, clean accommodation for the residents. EVIDENCE: Since the last inspection a new carpet has been laid in the main hall and lounge. The décor and furnishings in the home are of a good standard and the home’s handy man keeps on top of every day maintenance jobs (maintenance book viewed). Residents and relatives stated that the home is always kept very clean and tidy and this was evident when touring the building. The laundry room was not seen at this time however bathrooms and toilets were all hygienic. The home has an attractively decorated lounge on the ground floor and conservatory on the first floor. There is also an additional cosy seating area on the first floor landing with comfortable armchairs and a TV. Meals are served in the lounge, conservatory or residents’ rooms if preferred. There is no separate dining room. A resident reported, “The home is just kept so nice and feels like home”.
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 17 A key pad operates the doors on the first and second floor landings and also the main front door to ensure the residents are kept safe at all times. Safety valves are fitted to bath taps to ensure hot water is delivered to a safe temperature. Hot water temperatures had not been checked for the month of October however this was rectified at the time of the inspection and the test proved satisfactory. The exterior of the home is well maintained and there is car parking space to the front. A ramp us used for wheelchair access to the main front door. The main office for the Dovehaven group of homes is situated in a separate building at the rear of the home. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The home has an established staff group who have a range of skills and are employed in sufficient numbers to meet the needs of the residents. Some staff however had not received the necessary training to ensure competency in their role. Recruitment procedures were not robust to safeguard and protect the people living in the home. EVIDENCE: A registered nurse is on duty twenty four hours a day and the inspection of the staffing rota and direct observation confirmed that sufficient numbers of staff were on duty at the time of the inspection. Twenty four residents were residing and during the morning the manager, a registered nurse and five members of care staff were on duty. Relatives reported that the staffing levels are generally good and consistent. On occasions, agency staff or ‘bank’ staff are used to fill outstanding shifts. A member of the care staff continues to assist the cook in the mornings with general kitchen duties as there is no appointed kitchen assistant. Consideration should be given to this appointment to enable care staff to remain with the residents. Comments from relatives regarding the staff included, “Very good”. “Could not ask for better”, “Val leads an excellent team”, “Lovely staff, just so nice coming to the home” and “The care is always good.”
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 19 With regards to recruitment a list is kept of POVA checks sent for and received. CRB (Criminal Record Bureau) enhanced disclosures are also kept in staff files. Recruitment practice was found to be generally robust however it was noted that one new member of staff employed had commenced work prior to receiving POVA clearance which is a requirement prior to employment in order to protect residents from known abusers. Another new member of staff had not started work as the manager was waiting for POVA clearance. Job application forms had been completed by both members of staff with details of previous employment and a health declaration. References had also been obtained. New staff receive an induction ‘in house’ and attend an external study day (in line with TOPPS training) which is held locally. The induction for one new member of staff was seen and it is recommended a more detailed record be kept as at present the home’s induction form is a ‘checklist’ only. Details of health and safety, care practice, personnel issues and general management of the home should be recorded and induction material should relate to the employee’s position. Training for staff is ongoing however a number still require certification in food hygiene to provide them with the knowledge to undertake this work. Manual handling training was given to all staff earlier this year and a programme for first aid has been introduced. Infection control training is ongoing and health and safety issues are discussed during the induction process. Staff records and the training matrix however did not evidence an up to date record of dates and courses attended. All training undertaken by staff must be recorded. NVQ at Level 2 and Level 3 continues for staff and the home has achieved over 50 with NVQs. Dementia care training and challenging behaviour is provided and the home has a good range of research based articles and literature for staff and relatives to view. A member of staff requested further dementia care training and this was brought to the manager’s attention. It was evident that the manager works closely with staff however consideration should be given to holding staff meetings, the last one was held approximately six months ago. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36 and 38 The manager and staff have regular contact with residents and relatives to ensure the home meets its aims and provides a quality service. The home is not responsible for the payment of personal allowances to residents however the owner maintains financial records. The home provides only informal support for the staff, which has the possibility of staff not fully understanding their role in caring for residents and their training needs not being met. Maintenance contracts and safety checks are undertaken of equipment and services to protect the people using the service. EVIDENCE: A number of relatives confirmed that the manager has an ‘open door’ policy and is always available to discuss care issues or any concerns. Relative meetings are not held as relatives do not feel they are needed at this time. With regards to quality assurance, satisfaction comment cards are given to residents and relatives to complete and the manager is sending these out over
Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 21 the next few months. Previous comment cards were not available for inspection. The manager works closely with staff to audit the care, staff training requirements and the overall service provided. Consideration should however be given to providing more written evidence of these audits as part of the home’s quality assurance process. The owner deals with payment of resident’s fees, contracts and financial matters. The home is not responsible for the payment of personal allowances directly to residents. The manager meets with staff however formal supervision is not being carried out on a regular basis and the manager must develop this further. Records must be kept of staff supervision. Maintenance contracts for equipment and services to the home were seen and these were in date. An annual check is carried out of all fire prevention equipment and generally fire alarms are checked weekly and emergency lighting monthly. These checks had not been carried out for October however this was undertaken at the time of the inspection. Staff receive fire awareness training ‘in house’ and from the home’s engineer. Accidents that affect the well being of residents and staff are recorded. Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 22 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 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X 3 3 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 X X 3 X 3 2 X 3 Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 23 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 OP29 Regulation 19 Requirement All staff must recive a POVA first check and clearence prior to commencing employment in the home. The home must provide food hygiene training for staff (timescale of 1/8/05 not met) The home must keep records of staff training (timescale of 1/8/05 not met) The home must provide supervision for staff Timescale for action 22/11/05 2 3 4 OP30 OP30 OP36 18 18 18 02/01/06 02/12/05 02/01/06 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 OP27 OP27 OP30 OP33 Good Practice Recommendations A kitchen assistance should be appointed Staff meetings should be held regularly The induction for new staff should be recorded in more detail Audits for quality assurance should be recorded Abbendon Nursing Home DS0000017215.V263093.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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