Inspection on 14/02/06 for Abbey Care Home

This inspection was carried out on 14th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbey Care Home 06/12/07

Abbey Care Home 23/05/06

Abbey Care Home 16/02/05

Abbey Care Home 17/06/04

Abbey Care Home 11/03/04

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

CARE HOMES FOR OLDER PEOPLE Abbey Care Home Collier Row Road Collier Row Romford RM5 2BH Lead Inspector Mr Roger Farrell Unannounced Inspection 14th February 2006 12:45p 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 Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 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. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Abbey Care Home Address Collier Row Road Collier Row Romford RM5 2BH 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) 01708 732658 0207 437 1137 Corvan Ltd Vacant Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: Abbey Care Home provides accommodation and support for twenty older persons, mostly those who have dementia. This privately owned care home was purpose built, and is in a semi-rural location about a mile away from the main shops and transport links of Collier Row. A local bus stops outside the home. All bedrooms are singles, but are quite small, though they have their own en-suite wcs. It has a lift between the ground and first floors. The main communal room is an L-shaped combined lounge and diner. There is a second small lounge on the first floor, but this is not used much. One major drawback is that there are only two small bathrooms, but these both have special baths. Mr Anil Patel bought the home just over two years ago. He tried to get planning permission to expand the home, including increasing the limited communal space and adding bathrooms and toilets, but was not successful. He is now looking at other ways to solve space problems, such as adding a conservatory. There is plenty of garden space at the side and rear, and a large front forecourt for parking. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 12.45 and 5.50pm on Tuesday 14 February 2006. The main purpose was to check on progress with the lengthy list of 25 requirements set in the last report. That report covered an announced inspection on Tuesday 12 July 2005, and an unannounced visit the previous Friday evening on 8 July 2005. Most of the main standards were covered at those visits. A copy of that report is available at the home, and can be seen on www.csci.org.uk. Residents who gave views said they were satisfied, but the report highlights a range of concerns. This included the number of accidents and how they were being reported and monitored; fire safety; cramped communal facilities; using private en-suite loos because of a lack of communal wc’s; and the poor standard of care records. Adult protection managers from the two councils who sponsor most residents had also visited the home regarding concerns about falls and other safety issues. The registered manager in post when Mr Patel took over was away a lot, and her relationship with the owner was stressed. She left in November 2004 and Mr Patel had to oversee the day-to-day running of the home. In January 2005 a new manager started. However, the owner had not carried out sufficient checks; did not tell the Commission about the appointment; nor provided an application to register a new manager. There were a series of contacts and meetings between the owners and the Commission about the conduct of the home. An issue raised in the last report was that the manager had redone all the care plan files. These were too basic, incomplete and repetitive to be of any practical use. For instance, the hospital-style forms introduced as the main care plans were a series of broad bullet points using stock clichés such as ‘Provide dignity at all times.”; and - “Maintain Nurse/Resident relationship based on trust/empathy/honesty.” An analysis of accidents over a couple of months showed how the record systems were failing at a rudimentary level – one example being a daily entry for a resident saying - “a lovely quiet day.” – when in fact this person had gone to hospital that day with a broken wrist, the cause of which was unknown. Of further concern was that some entries were derogatory. The announced visit on 12 July 2005 included the inspector giving extensive advice on the reforms necessary to meet the required standards. The report asked for a detailed ‘action plan’ on how the long list of requirements would be achieved. The response was concise, mainly saying that all matters had been completed. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 6 At the end of October 2005 the Commission received an anonymous complaint making a series of allegations, including responses to residents when they were showing distressed behaviour. The local adult protection guidelines were followed, including involvement of the police and adult protection managers from two councils. In line with the required procedures, the owner suspended the manager. Mr Patel was again obliged to take responsibility for the day-today running of the home. There was an additional monitoring visit on 16 November 2005. On 9 December 2005 the owners wrote to the Commission saying that the manager had been dismissed. At the meeting that followed with managers from the Commission Mr Patel said that he had recruited a new manager. Further, two consultant advisors with experience of operating a care home had been called in to lead the introduction of reforms. They would initially be involved for three months, with the option to extend their advisory role, such as doing the monthly monitoring visits. They already knew the new manager, having provided her with support at another home. The Commission’s pharmacy inspector carried out a medication audit and advisory visit on 9 January 2006 and provided a report. This set out twenty-six areas of advice and recommended improvements. The owner is a qualified pharmacist. It was one of these consultant advisors who dealt with the inspector’s enquiries at the recent visit on 14 February 2006, with the second advisor being present for part of the visit. The new manager was away. What the service does well: The advisors did an initial room-by-room safety analysis, identifying defects that needed quick attention. This included for example - fitting some grab rails and support frames, a check of the fire alarm system, and introducing individual linen. At the end of January 2006 the following items were sent to the Commission: • Revised ‘statement of purpose’ and ‘service users’ guide’; • An ‘interim report’ from the advisors. This sets out the actions taken to achieve improvements in line with the requirements listed in the last inspection report; • An accident analysis report covering the 17 incidents that occurred between 30 August and 16 December 2005, with recommendations specific to individuals, and other general risk reduction measures; • A room-by-room maintenance and risk analysis; • An ‘action plan’ in response to the pharmacy inspection, with revised policies; • Copies of the range of care plan forms being introduced. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection? What they could do better: There are now credible signs that this home is being turned round. This follows a year when the operation of this service, including the level of accidents, were a major concern to the Commission and the councils that pay for places. There have been two adult protection investigations. Little was done to deal with the building’s design shortfalls. It is now over two years since Mr Patel bought the home. He has not succeeded in establishing a stable and competent manager presence that - provided leadership to the team; guide good practice on the care of people with dementia; and gain the confidence of professionals. There has been a failure to keep other key agencies informed, including notifying the Commission of serious events such as the incidence of accidents. He recognised a crises point had been reached last November. The Commission said that unless urgent and effective measures were taken, then they would proceed with legal action. To his credit, he called in advisors and gave them the hands-on jurisdiction to tackle the extensive range of deficiencies, and propose further improvements. Part of this package was to support the new manager’s transition. The advisors have also identified merits. Top of the list is the positive view they have of the care and support staff. In particular, they acknowledge the team’s commitment to be part of the necessary changes, and this includes a keenness to receive more training. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 8 The general findings of this visit were positive. The advisors have been at the home most weekdays over the last couple of months. The owner sees them at the home at least three times a week. They have taken a lead in kick-starting improvements in all the areas set out as being deficient in the last inspection report. This progress is welcomed and acknowledged. However, this report carries over eight requirements. This is because the inspector wants to make sure that the worthwhile reforms are maintained and progressed by the new manager and owner. Providing a more credible action plan than was the case last year is an expectation, as all items will be followed up to make sure that solutions are durable. 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. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The last report asked for four main improvements under these headings. Two are now recorded as met. Good progress has been made with introducing a much better approach to recording assessments. However, this item is carried forward as it will be checked at the next inspection when more examples will be available. The new ‘service users’ guide’ offers some basic information, but is generally of little use and badly edited. EVIDENCE: The four main improvements asked for in this section were: • ‘Have available an up-to-date statement of purpose. This needs to list the size of each room, including the usable space of each bedroom, with the en-suite space shown separately. Details of the new manager need to be added.’ A new ‘statement of purpose’ has produced using a commercially available standardised version. A provisional entry has been made covering the new manager, confirming that she has the Registered Managers Award. It has entries covering all the necessary areas. The inspector did point out a few Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 11 amendments that are needed, including – not mixing metric and imperial when giving the size of bedrooms (prospective residents need to be told that bedrooms fall short of the recommended minimum level); include the size of communal rooms; use the right name of the Commission (Section 25.0), and don’t confuse inspectors with local authority ‘commissioning officers’ (page7); and it is helpful to be more specific about the staff complement and number of care hours provided. A recommendation has been made on these points. • ‘Have available an up-to-date service users guide, ensuring that all information is factually correct. Include a copy of the contract used to cover residents who pay their own fees.’ All residents have been given a copy of the new ‘service users’ guide.’ This gives very basic descriptions of the facilities, with lots of general promises about the quality of care. It skips over some important areas, such as saying a complaints procedure is available rather than giving any worthwhile guidance. The home is registered to support people who have dementia, but nothing is said about how such needs will be supported. Large bold print is used, but the poor editing, lack of detail, and sloppy presentation are unlikely to impress or to be of much use to those looking for a care home. The advisor did say that a more specific ‘A to Z Guide’ with pictures was planned. This requirement is carried forward. • ‘Have available a copy of the standard contract used by each local authority who place residents in the home.’ The advisor was confident that they had copies of the standard contracts covering residents who have help with their fees from local authorities. The home falls just within Barking and Dagenham, but Havering Council pay for most places, currently just over half. Havering Council’s contacts monitoring officer had carried out an inspection on 8 January 2006. The most recent resident to move in was paying their own fees, but council sponsorship was being sorted out. There is one established private resident. A contract is available covering the terms and conditions for private residents. The inspector queried why this is referred to as a ‘pre-placement contract’, as it is the legal agreement covering obligations once a person has moved in. • ‘Have available on each service users file a copy of a sufficiently detailed assessment. This must include all areas listed in Standard 3.3.’ Examples of assessments seen at the last visit were limited to the former manager doing a few jottings of the referral information received from a social worker and a hospital report. The samples of new style files seen at this recent visit were much improved. This included the file of the resident who had moved in a couple of weeks earlier. There were good referral reports from the Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 12 social worker, a psychiatric report, and hospital discharge summary. A sixpage ‘service user pre-assessment form’ had also been completed. There is also a system for calculating dependency levels. This shows that a considerably more methodical and accountable approach is being introduced. The inspector said that this requirement would be carried-over as he wanted to see how it was being used over a longer period, including where there was not such helpful referral information from others. Nevertheless, this significant improvement is acknowledged. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The positive headline finding is that a much more detailed and systematic care planning system is being introduced. EVIDENCE: The last report said that there must be improvements under these headings, including: • ‘Have available for each resident an up-to-date service user file. This must include personal details and a photograph; an assessment of needs; a current care plan setting out the support needed by that individual; monitoring records, including contact with all health care workers; and periodic reviews of the service and facilities. All relevant care needs must be identified in the care plan and the home must demonstrate that they are meeting them. Care records must be clear, and service users must not be referred to in derogatory terms.’ • ‘As appropriate, include in service users files risk-assessments, including covering the risk of falls. All advised arrangements must be covered in the care-plans, including the measures to prevent injury.’ DS0000053550.V283390.R01.S.doc Version 5.1 Page 14 Abbeycare Home The advisor gave a detailed description on the overhaul of the care records. The new formats had so far been introduced for about a third of residents. The inspector looked at a sample of three files that had been completed. This includes a series of assessment and monitoring schedules that the advisors have used in the past, including risk profiles covering physical health, mental health, moving and falls assessment, skin viability, fire safety, and medication. The style of care plan sheets is much more in keeping with modern standards. The inspector welcomed these improvements. He did say that some of the care plan entries were quite brief, and it would be better to have a page-perheading or a simple grid system. As with the assessment standard, the positive progress is acknowledged, but the requirement under Standard 7 has been carried forward as this important area will be rechecked once it is fully introduced. The advisor said they were now at a stage where they would be allocating specific ‘key-working’ tasks to staff. The new files have medical tracking forms that will be used to record all contacts with GP’s and other health care workers. Details had been entered in one of the three files seen. The advisor expected that all residents would have up-to-date new files within six weeks. As stated earlier, a detailed medication audit was carried out 9 January 2006 by the Commission’s specialist pharmacist inspector. The advisors responded with a point-by-point action plan saying how all the recommendations have been introduced. At this visit the inspector was shown the improved medication record file, including individual forms and photos. Previous reports have challenged the unacceptable practice of using the private en-suite wc’s as general communal loos, and trying to give the impression that this is no longer happening. Requirements on this matter included: • • ‘Arrange care practices in such a manner that ensures the privacy and dignity of all service users. Do not use the private facilities of a resident for others, such as en-suite toilets’; ‘Provide an adequate number of lavatories in appropriate places in the premises.’ Absolute assurances were given that bedroom en-suite wc’s were now never used for others. New toilets have been fitted in the ground and first floor bathrooms; the larger former staff-only wc opposite the kitchen is now used by residents; there is a plan to convert an end-of-corridor storeroom into a staff changing-room that may include a staff toilet; and the more modest extension proposal may include a new ground-floor shower and loo. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 15 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): 0. The standard covering meals was rated as satisfactory in the last report, including quoting the opinions of resident, such as - “I’m a person who always likes a second cup of tea, and that’s alright. I stay up quite late and do ask for tea up to 11 o’clock. I get plenty to eat, and there’s never any argument over what you want.” Revised documents such as the ‘statement of purpose’ and ‘service users’ guide’ say there is a regular programme of activities, and visits from outside entertainers. This area will be checked at the next visit. EVIDENCE: All residents who were able to give an opinion at the last visit said that they were happy with the standard of meals, and that they were offered choices. Meal sittings were found to be relaxed, and staff were attentive to individual’s needs, such as offering a choice of drinks. The inspector noted that most of the stocks were ‘value line’ brands. However, there is a farm shop close by, and it was again confirmed that it is used regularly, including for fresh vegetables. The cook said that he is happy with the quality of foodstuffs. Food storage and better stock monitoring are covered in the advisors’ report. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. There is sufficient information on display about how to make a complaint. This includes on the main notice board in the hall, and a copy has been put in each bedroom, though it would help if this is also included in the proposed ‘A to Z Guide.’ Information on detecting abuse is now more readily available and discussed. All staff have attended training on this matter, and the induction checklist covers complaints and protection. EVIDENCE: The following two requirements were made in the last report: • ‘Ensure that all staff are informed of their responsibilities covering adult protection procedures, including providing all staff with a copy of the GSCCs code of practice.’ ‘Have available a policy and guidelines covering alleged or suspected abuse that is specific to this service.’ • Barking and Dagenham’s adult protection manager provided a training session on signs and responses to suspected abuse or neglect to fourteen staff on 7 December 2005. This was part of the response to the anonymous complaint that had raised allegations about the style of management and physical interventions. There is a pack on responding to abuse on the office notice board called ‘Report It’. The home’s revised ‘whistle blowing’ policy is also on display. Copies of all the main guidance are available, including ‘No Secrets’, the local Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 17 adult protection guidelines, and other versions from councils who use the home. Staff have also signed to say that they have been told about the role of the General Social Care Council, including the phased programme of signing-up - and that they have been given a copy of the main code of practice. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Although this home was purpose-built only fifteen years ago, there are functional problems to do with a lack of space. Bedrooms and communal areas are well below the recommended standards introduced four years ago, but these did not apply to existing homes like the Abbey Care Home. Ideas are being considered to improve matters. This must look closely at issues that have been a problem - like any link to accidents, fire safety, and having adequate bathing facilities. Recent improvements have included dealing with the shortage of communal loos. EVIDENCE: The building is set well back from the busy Collier Row Road, with a large front parking forecourt. It is on a generous plot in a semi-rural location, with plenty of garden area to the side and rear. The owner’s initial planning application to make the home larger was turned down because it is on a ‘green-belt’ site. The original planning permission restricted the home to the size of the building it replaced. Nevertheless, initiatives need to be taken to improve the existing facilities. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 19 Last year’s reports stressed the importance of not propping open the critical fire doors from the hall into the main communal room, and the next one leading out towards the kitchen. These two doors are fitted with emergency release latches, but were routinely propped open with furniture. This lack of protection from fire spread was even further compromised as the adjacent kitchen door was often propped open with a wedge. Requirements covering this matter were: • • ‘Comply with all advice contained in reports provided by the Fire Authority, including ensuring that the kitchen door operates as an effective fire barrier.’ ‘Ensure that all fire doors work effectively, including being free of obstacles that prevent effect closure, and have locks that can be released easily.’ Assurances have been received that all staff now understand the importance of making sure these doors are free to close. Moving the dining table from that throughway has helped. The good news is that they were found to be free of obstacles at the last two unannounced visits. When asked, staff confirmed they were aware of the importance of this matter. The owner and manager need to make sure that this essential safeguard is maintained. The last visit by a fire safety inspector (LFEPA) was on 19 August 2005, and this confirmed satisfactory arrangements. In effect, the ground floor lounge/diner is the only communal room. There is little evidence that the smaller upstairs lounge is used, other than occasionally by visitors. The ’L-shaped’ ground floor lounge/diner is understood to measure 52sqm. This means a ratio of 2.6sqm per resident, which is well below the advised minimum level of 4.1sqm. The restricted communal space means that the only way to set out the lounge chairs is in tight rows along the walls. The problem with providing enough lounge space needs to be solved. At this visit the second advisor showed the inspector initial basic drawings of a conservatory extension to the lounge/diner. The idea is to gain the maximum additional space permitted without breaching planning restrictions. The inspector’s initial advice included: • To fully research temperature control – to ensure adequate heating in the winter, and protection against overheating in hot weather such as air-conditioning and reflecting blinds; • To get an early stage opinion from the fire authority, including on altered means of escape; • To achieve level and trip-free access. Overall better attention is needed to maintain the appearance of the building. An example is how old furniture and equipment has been dumped around the outside paths and patio area. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 20 Other requirements covering the building included in the July report were: • • • ‘Have available a record of the routine maintenance of the premises, including the action taken to deal with defects.’ Maintain the grounds in a safe and tidy condition - including removing the discarded furniture and equipment from the periphery path; and securing the side fence leading onto the forecourt.’ Maintain adequate standards of decoration, including in bathrooms. This should be designed to achieve homely conditions, including providing lampshades. The extent of defects found in the advisors’ ‘room-by-room analysis’ six months later showed that a slapdash approach persisted despite the commitments made in the ‘action plan’ response. That inspection report also said that little pride was being taken in the building’s general appearance, such as old furniture and equipment being dumped around the outside path. It added that recent redecoration was limited to using white paint on walls. This was in danger of increasing an institutional appearance. It was also contrary to the advice that contrasting colours can be helpful for people with dementia. By the time of February visit a skip had arrived the day before to get rid of rubbish. A programme of internal decoration was being carried out. This had included brightening-up the two bathrooms. The inspector was shown evidence where at least five residents and their families had been involved in choosing new colour schemes for their bedrooms. A more up-to-date room audit and risk assessments had been carried out. The advisors had been given the authority to call in a maintenance man. At this visit he was fitting new worksurfaces and cupboards in the kitchen. The inspector looked at a sample of eight bedrooms. The advisor showed how better attention to detail was being encouraged, like ensuring that curtains were hung correctly and that each resident had their own linen and towels. Two of these requirements have been carried forward as the inspector wants to make sure that the owner and new manager continue with the attention to detail initiated by the temporary advisors. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 21 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, 29 and 30. The consultant advisors are carrying out an analysis of staffing levels, vetting, and training and qualifications. They are introducing better records that will make it easier to give accountable summaries in these important areas. This is important because last year some claims about checking references and qualifications were misleading. EVIDENCE: The requirements set in the last report under the staffing section were: • • • ‘Have available details of staff who have a relevant qualification (NVQ at level 2 or above), and those currently working towards such an award.’ Carry out adequate vetting of staff, including obtaining two references and taking steps to establish their authenticity.’ ‘Include in the statement of purpose details of the staff complement (the number, designation and hours of each post, including ancillary staff), and the level of cover on shifts.’ The advisor was able to provide some good evidence on progress with the first two items. Individual training profiles have been set up for each worker. There is also an overall training matrix chart. The expectation is that care homes have at least 50 qualified staff. It is good news that this target has been achieved. Eight of the fifteen care staff have NVQ Level 2, four of whom are carrying on to do Level 3. Four staff have signed up start Level 2. The inspector said that copies of NVQ certificates need to be kept on staff files. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 22 The advisor was still working on a staffing level analysis. She was using the approved ‘SCA’ formula that takes into account in the calculation current residents’ dependency levels. Some changes in the shift times introduced by the last manager have been reversed. However, the level of cover remained the same at present, subject to the advisor completing her analysis. Normal cover is three care staff on the morning shift (7.30am to 2pm); three on the late shift (2 to 9pm); with two waking night staff (9pm to 8am). This does not include any of the manager’s hours, who normally works 8am to 4pm Monday to Friday. Of the fifteen care staff, ten are seniors, meaning that they can be ‘shift leaders.’ There is a chef everyday between 8am and 2pm, and a domestic assistant six days a week between 8am and 1.30pm. The recent rota showed only one instance of a person working a ‘long-day.’ At his last main visit the inspector found that the then manager and the owner were failing to carry out adequate checks. For instances, one reference accepted as provided by a ward manager was in fact from contract cleaner. The owner is aware that he Commission takes a serious view on failures to carry out thoroughly the required range of checks and verifications. Failure to do so will result in legal action. One of the advisors had made good progress on going through all staff files to make sure that all checks had been carried out, and that supporting documents were authentic. He was meeting with each staff member to go through their details. He showed the inspector the audit he was using, and confirmed that all had CRB certificates obtained through Havering Care Association. A sample of staff files will be audited at the next visit. The requirement on this standard has been carried forward. The owner was asked to include in the ‘statement of purpose’ the staff complement (the number and type of posts, and the contracted hours, including ancillary staff), and the level of cover on shifts. An organisational chart is included, but more detail would be helpful. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38. The owner needs to establish a consistent, competent managerial presence to ensure compliance with these standards and build confidence in the home’s ability to safely meet the needs of residents. EVIDENCE: At this visit the inspector said that the new manager must proceed with applying for registration. The need to obtain a fresh CRB certificate, verified by the Commission was stressed. A requirement has been set on this matter. Requirements made under this section in the last report were as follows: • • ‘Notify the Commission regarding any significant events regarding the operation of the home, including changes to the conditions of registration such as the appointment of a manager.’ ‘The home must notify the Commission of all significant events affecting the welfare of service users.’ DS0000053550.V283390.R01.S.doc Version 5.1 Page 24 Abbeycare Home A major concern to emerge from the two adult protection investigations carried out last year was that serious events, such as falls and other accidents were not being notified to the Commission. There is a legal duty to report such incidents. Some notifications were so scrappy that they could not be read. This was subsequent to the failure to tell the Commission that a manager had been appointed in January 2005. The previous manager had also failed to keep others involved, such as telling a commissioning office that he was giving a resident notice to leave, but not telling the social worker. There were also delays in telling residents’ families when an accident or incident had happened. At this visit assurances were received that all events covered by Regulation 37 are being notified to the Commission without delay. Also, residents’ families and social workers are contacted if there is a problem. There is now a supply of clear accident/incident forms at the home that are being used. All contacts with the Commission are routinely logged. At a subsequent visit the inspector will double-check to make sure that all reportable incidents are being notified. The requirement on this matter is therefore carried forward. • • ‘The registered person must ensure there is a review of the level/causation of accidents - including manual handling practices and a staffing level review.’ ‘The results of the above review must be forwarded to the Commission.’ The advisors carried out an accident analysis covering the seventeen incidents that had been recorded between the end of August and mid-December 2005. This concluded with five main recommendations, including maintaining an adequate staff presence in the main lounge where the highest number of accidents occurred. Other practical solutions included using electrical circuit breakers and using a bracket to secure a tv. In a couple of instances medication reviews were advised. There are now a much wider range of individual and general risk assessments. Greater emphasis has been placed on making sure staff have training on judging risks and dealing with challenging behaviour. The advisor was confident in asserting that there has been a significant decrease in accidents. • • Have available a current gas safety certificate. Carry out periodic health and safety checks of the building and grounds, and maintain a record. An up-to-date annual gas safety certificate was issued on 25 August 2005. The advisors showed evidence of much better health and safety monitoring. This has included setting up a new fire log, including weekly checks. These include making sure that the critical fire doors referred to above are free closing. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 25 The new manager and owner must make sure that the increased level of safety monitoring continues once the advisors decrease their involvement. The inspector was told that a specialist health and safety consultancy firm had been contacted about setting up a support package. Standards 33 and 35 will be checked at future visits. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 26 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 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? Yes – Items 1 to 8 are carried forward. 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 OP1 Regulation 5 Requirement Timescale for action 30/04/06 2 OP3 OP4 14 3 OP7 OP8 15; 12(4)(a) 4 OP19 23(2)(b) Have available an up-to-date service users guide, ensuring that all information is factually correct. This needs to include the areas listed in Regulation 5 and Standard 1.2. Have available on each service 30/04/06 users file a copy of a sufficiently detailed assessment. This must include all areas listed in Standard 3.3. Have available for each resident 30/04/06 an up-to-date service user file. This must include personal details and a photograph; an assessment of needs; a current care plan setting out the support needed by that individual; monitoring records, including contact with all health care workers; and periodic reviews of the service and facilities. All relevant care needs must be identified in the care plan, including those resulting from dementia. Have available a record of the 30/04/06 routine maintenance of the premises, including the action DS0000053550.V283390.R01.S.doc Version 5.1 Abbeycare Home Page 28 5 OP19OP21 23(2) 6 OP29 19(1)(c) 7 OP31 37;8(2) 8 9 OP25OP38 OP31 13(4) 8; 9 taken to deal with defects. Maintain adequate standards of decoration. This should be designed to achieve homely conditions. Carry out adequate vetting of staff, including obtaining two references and taking steps to establish their authenticity. Notify the Commission regarding any significant events, including all accidents. This must also cover any changes to the conditions of registration such as the appointment of a manager. Carry out periodic health and safety checks of the building and grounds, and maintain a record. Provide an application to register a manager. 30/04/06 30/04/06 25/03/06 30/04/06 30/04/06 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 Refer to Standard OP1 Good Practice Recommendations Make the suggested corrections to the ‘statement of purpose,’ as pointed out on pages 12 and 23. Abbeycare Home DS0000053550.V283390.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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