Inspection on 23/05/06 for Abbey Care Home

This inspection was carried out on 23rd May 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 14/02/06

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 Key Unannounced Inspection 23 and 24 May 2006 11:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbey Care Home DS0000053550.V296807.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. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 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 post Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 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 which is now being used. 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. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Tuesday 23 May 2006 between 11.45am and 4.45pm. The inspector returned the following day between 10am and 1.30pm. The last announced inspection report in July 2005 raised a range of concerns. It listed 25 requirements. Following the departure of the manager, the owner called in two consultant advisors in December 2005, who introduced a new qualified acting manager. They carried out a number audits of the service and facilities, and drew up an action plan to tackle the improvements asked for in reports and other matters such as building defects. The last inspection was an unannounced visit on 14 February 2006. This set out the progress that had been achieved. Eight of the items were repeated. The one additional new requirement was to submit an application to register a manager. Just ahead of this recent inspection the owner wrote to say that the acting manager had decided to leave. She gave an undertaking to stay on for about three months whilst a new manager was recruited. The two advisors also offered to remain involved with the home, but would reduce the time they spent on site. The two advisors and acting manager were available over the two days of this visit to assist the inspector with his checks. He also had a meeting with six staff. A questionnaire has been sent to relatives and visiting professionals, and these will be considered as part of the next inspection. The inspector is grateful to those residents who made comments. What the service does well: Last year’s main report set out a wide range of concerns about how the home was operating and problems with the facilities. Improvements were asked for in twenty-five areas. By the follow-up visit in February 2006 significant progress had been made. The consultant advisors and acting manager have consistently praised the dedication and commitment of the staff. They recognised that there had been a lack of positive leadership, and staff have said that they did not have confidence in the way the home was being managed, including where there was difficult behaviours to manage. At this visit the inspector found a much stronger level of mutual support and unity. One staff member said – “It is much better. {Last year} there were times when it felt quite dreadful. But now it feels much better, and it is still improving. There are much better ways of working…we now have systems to follow.” Another view was – “I am happy, and would say that it is a happier place for everyone. The training we are now getting is helping the improvements. We can speak to {the advisors and manager} and know they are listening. Things get discussed, such as in staff meetings.” One of the advisors said – “We recognised early on that it was a strong staff team…..I Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 6 would go as far as to say ‘brilliant’. They have been so open to making improvements and to work with us.” The acting manger was keen to stress that she shared this opinion, adding – “I would say that they are wonderful.” This strong foundation is helped by the number of staff who are gaining qualifications. What has improved since the last inspection? 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. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 7 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 Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 8 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 quality rating in this area has risen to ‘good’ – with all five outcomes scored as satisfactory. This is the result of having much better systems for carrying out pre-admission assessments, and having available much better information on what the home offers, including in the ‘Visitors’ Information File’. EVIDENCE: No new resident has moved in since the last inspection. The inspector looked again at the file of the most recent person to move in four months earlier. This had a considerably better range of information than had been the case for new residents last year. This included good referral reports from the social worker, a psychiatric report, and hospital discharge summary. A six-page ‘service user pre-assessment form’ had also been completed. There is also a system for calculating dependency levels. This showed that a considerably more methodical and accountable approach is being introduced. The new range of much improved practice documents now include a ‘service user pre-assessment form’. This is well designed and comprehensive – and includes assessment schedules covering all the physical, psychological and Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 9 social needs asked for under Standard 3.3. The information and risk ratings follow on logically to set up the initial care plans described in the next section. It was confirmed that it would still be the manager who carried out all initial assessments on those referred. This would involve insisting that the referring agency supplied a sufficiently detailed referral report, including social history. The home does not offer short-term respite care or take emergency admissions. These strong improvements in the framework for assessment are fully acknowledged, and the requirement on this item is now scored as achieved. However, the inspector will check how the new formats have been used for new residents at subsequent visit. The advisors and acting manager have also improved information about the home. This includes revising the ‘statement of purpose’ and ‘service users’ guide’ (‘Residents’ Handbook’) as asked for in the last report. This includes using photos, having an ‘A to Z’ guide, and setting out the level of staff cover, and a copy of the standard contract of residency used with those who pay their own fees. There is a copy of the ‘service users’ guide in each bedroom. Also, there is a helpful ‘Visitors’ Information File’ in the entrance hall. This includes the ‘statement of purpose’; how to make a complaint; safety and protection policies; and a copy of the last inspection report. This review of how information is made available also includes removing pins on the notice boards to avoid accidents. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 10 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, 10, and 11. The quality rating under these heading has also been raised to ‘good’. The principle evidence is the considerable improvements that have been achieved in the care planning records. The new files are much better at assessing and monitoring physical well being and recording contact with doctors and other health care workers. The care needs and monitoring of residents is now set out in a much more systematic way. EVIDENCE: Last year’s main report said that the then manager had redone all the care plan files. The result was too basic, incomplete, and repetitive to be of any practical use. 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.” At the last visit in February 2006 a good start had been made on overhauling the care plan files. The acting manager and advisors have now set up new files for all residents using considerably better formats. The acting manager has shown commendable skill in designing and adapting a comprehensive series of Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 11 assessment, care plan, monitoring and review formats that now make up the ‘Care Plan Files’ and ’Daily Living Record’. These files are set out in ordered way, with a front index and profile sheets with a photo. In addition to the ‘service user pre-assessment form’, there is a ‘care plan based on needs and risk assessments’ using all the required headings. It is particularly strong because it uses straightforward risk assessments covering essential areas such as physical and mental health; behaviour patterns; falls; skin viability; mobility; moving and handling; and nutrition. These are then used to set out the current support needs and monitoring. As promised, there is now a system of allocating each person a ‘key worker’. In addition to the day-to-day notes, a ‘Key Worker Weekly Check’ list has also been introduced that monitors care such as personal appearance and conditions in bedrooms. There are still some gaps, such as the in-house ‘service user annual review’ not yet having been completed. However, the new system is a major improvement. The home now has a modern, well-designed, accountable practice system that has replaced the largely worthless revision carried out last year. Attention to detail includes keeping the main files in a sling trolley that staff can use, confirming their active involvement in using the essential monitoring sections. The last two inspection reports talked about the major concerns regarding the rate of accidents and injuries. This included a failure to keep accurate records, and to report these matters to the Commission and social services – and keep families informed. Adult protection managers from two local councils had become involved, including carrying out investigations. A few weeks after they started the advisors produced a number of initial audits and reports. This included an analysis of the pattern of falls and injuries. The main lounge/dining area had been rearrange to reduce the hazards at the congested throughway, and ensure a consistent staff presence in this communal area. Six months on they report a significant decrease in the number of accidents, and that recording and reporting have been improved. They are in the process of doing a comparative analyse of the accident trends between their pre-start and subsequent six-month periods. A copy of this will be sent to the Commission. The much-improved approach to documenting care needs includes monitoring physical health and recording consultations and treatments. This included having a GP letter, hospital discharge letter, and renal report as part of the assessment section of the most recent resident. At this visit it was found that a review had been booked for the resident with the highest dependency needs to look at her decreasing mobility. On the first day of this visit a GP home visit was quickly arranged as a resident was showing distress and they wanted to eliminate physical causes. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 12 The advisors and acting manager advised the inspector to speak with the community nurses who visit to give their view on the standards of care and liaison. Whilst the logging and tracking record for medical contacts and treatments are much better, the inspector again spoke about the benefits of a straightforward ‘page per practitioner’ format. The Commission’s specialist pharmacist inspector carried out a detailed medication audit in January 2006. The advisors responded with a point-bypoint action plan saying how all the recommendations have been introduced. At this recent visit the inspector looked at the medication arrangements. Medication is provided by a local independent pharmacy in separate dose packs. The acting manager is not happy with the ‘nomad concise’ containers that are used, and they are due to revert back to the more rigid bubble cassette packs. The medication is provided with printed administration and signing sheets. There are individual medication profile sheets with a photo attached. Medication is kept in a purpose built trolley, which is kept anchor locked in a separate storeroom in the office when not in use. All conditions seen at this visit were satisfactory, including having a quite recent drugs directory. There have been no known errors this year. The supplying pharmacist carries out audits at the home. Her most recent report listed a number of recommendations that were being followed. All staff have done training on the safe handling of medication, with the shift-leader senior being responsible for giving medication. The main infringement of privacy was to do with the shortage of communal toilets. Absolute assurances have been received that the former practice of using private bedroom wcs for others has stopped since new toilets were fitted in the ground and first floor bathrooms. Residents now use the larger former staff-only wc opposite the kitchen. There is a plan to create a new staff changing room with a separate toilet. The conservatory extension proposal may include a new ground-floor shower and toilet. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 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, 14 and 15. The quality rating under these standards are ‘adequate’. There needs to be a more planned approach to supporting residents with social and recreational activities than is the case at present. Equally, there needs to be better attention to having evidence about the standard of catering and promotion of choice. EVIDENCE: In addition to the care plan and monitoring records referred to above, there is also ‘daily work plans’. In addition to allocating routine care tasks on shifts, such as support with personal care and bathing, this also says what activities have been arranged. There are two slots in the day where staff are expected to ensure activities, such as gentle exercise and choice of tv programmes. Beyond this, there is little evidence of planning. Three or four residents have had contact with clergy or church representatives, but better pastoral support is something the acting manager would like to see. Contact has been made with the local Age Concern branch to see what social opportunities could be considered. But in general, chances to go out are limited other than for the four or five residents who are helped by their family. The inspector saw photos of recent celebrations. The only recent planned entertainment event was cancelled by the performer at short notice. Residents who gave opinions said that they liked listening to music, and said that staff did ask them about what Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 14 cd’s to play. The advisors and acting manager agreed that improving the scope of recreational opportunities remains an area still needing improvement. Comments from residents about the standard of meals are generally favourable, though on this occasion two people used terms such as ‘Okay’ and ‘Alright’. The inspector was given an overview of the choices that are offered. The inspector has commented in the past that stocks tend to be predominantly ‘value lies.’ Assurances were given that fresh produce are used from a neighbouring farm and farm shop – and indeed such a delivery took place soon after the inspector arrived on the first day. The promotion of choice and presentation of food is an area that the advisors and acting manager say they are working to improve. The cook is keen to take on board new ideas, and is doing a qualification, which includes on-site tutoring. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 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): 16 and 18. The outcomes of these three areas are scored as ‘good’. This is based on the evidence that the correct guidance is available and staff have had training on what to do if there are concerns or complaints. An anonymous complaint made towards the end of last year contributed towards the reforms that have been introduced since then, along with the adult protection procedures that were used. There is now greater confidence that the systems are in place to better protects service users. EVIDENCE: Lat year requirements were set to make sure that there was an improved understanding of what needs to be done if there is an allegation or suspicion of abuse. Barking and Dagenham’s adult protection manager provided training on signs and responses to suspected abuse or neglect to fourteen staff. This was part of the response to an anonymous complaint last year 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. The home’s revised ‘whistle blowing’ policy is also available, along with copies of all the main guidance including ‘No Secrets and the local adult protection guidelines. Staff have 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. The induction checklist covers complaints and protection Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 16 There is sufficient information available on how to make a complaint, including contact details for the Commission. This is covered in the ‘Residents’ Handbook’ and included in the ‘Visitors’ Information File’. The inspector was shown the complaints logging system, and an explanation given on how the two recent complaints were being followed up with families. There is a form to record the outcome of each complaint. Confirmation was received that no money or other valuables are held for residents. Payment for expenses such as hairdressing, chiropody and toiletries are paid for by the home, and settled from time to time by families or social services. Nobody from the home acts as an appointee, or bank account representative for residents. In the one instance where there is no family or social worker, a solicitor acts for the resident. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 17 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, 22, 23, 24, 25 and 26. The quality outcome in this area is ‘adequate’. This judgement is based on space shortfalls matched against the National Minimum Standards for bedrooms and communal rooms. The advisors and acting manager have influenced some improvements – notably bringing the upstairs lounge into use – but the owner still needs to push ahead with solutions such as the proposal for adding a conservatory. EVIDENCE: The building is set 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. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 18 The last report said – “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.” The good news is that the upstair’s lounge is now being used by service users. A couple of residents who use this room told the inspector that they prefer this arrangement, and that there was usually a staff member available in this area. This adds a further 15 sqm or so to the usable communal space, but nevertheless the home still falls short of the recommended minimum space. At the last visit the inspector saw the plans to add a conservatory, and a shower-room with wc. At this visit he was told that a local builder was involved and that planning consent had been sought. The idea is to gain the maximum additional space permitted within the planning restrictions. The inspector has given the following advice: • To fully research temperature control – to ensure adequate heating in the winter, and protection against overheating in hot weather such as having 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. There are signs of better attention to maintaining the appearance of the building. Old furniture and equipment is no longer dumped around the outside paths and patio area, and the garden looks much more attractive. The inspector was told that residents are now being helped to use this pleasant space. Some window boxes have been planted out at the front of the building, which is a start in offsetting the plain, dull frontage. Another area audited by the advisors was safety and maintenance. Their ‘room-by-room analysis’ highlighted a slapdash approach to dealing with defects. Further, recent redecoration was limited to using white paint on walls, which 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. The advisors were given the authority to call in a maintenance man. He had tackled a good range of jobs, notably fitting new work-surfaces and cupboards in the kitchen. A new floor is due to be laid in the kitchen. The maintenance man had been unavailable for a number of weeks leading up to this recent visit. Therefore some work has been delayed, such as fitting new side fencing and carrying on with decorating bedrooms. The good news is that Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 19 residents and their families are now involved in choosing colours for their bedrooms. At this visit the inspector looked at the twelve bedrooms not viewed at the last inspection three months earlier. 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. Use is restricted due to their small size, such as limited storage space. But they do have the benefit of their own en-suite wc with hand-wash basin. All rooms were fresh and well arranged, with most having some personal touches such as family photos. Call bell cords were placed in reach, and all radiators have safety covers. Another recent improvement is that all first floor windows have safety-opening restrictors. A recent innovation has been to put a photo or other sign on doors to help orientation. There are only two bathrooms, one on each of the ground and first floors. These too are small, but have mechanical tilting baths. The standard is that there should be one bathroom for at least every eight residents. It is positive that adding a shower-room is included in the plan for the rear extension. The scale of the building and small rooms means that it is not suitable for service users with significant physical disabilities. At this visit there was one person who needed to use a hoist, but her future care was due to be discussed in a review that week. There is a lift between the two floors, and there are sturdy grab rails along the corridors. Assurances have been received that all staff understand the importance of making sure fire doors are free to close, notably those protecting the ground floor throughway from the lounge. This is part of a much better approach to fire safety monitoring. This has including removing the ineffective doorstop from the kitchen entrance. A fire safety inspector (LFEPA) checked the building and records a week before this visit and was satisfied with the arrangements. A contractor is due to install a keypad entry system on the front door to improve security. This will have an emergency release linked to the fire alarm. Another consequence of having small rooms is that the laundry has very restricted working space. The advisors said that ideas about revising the use of service rooms and stores may include ideas about relocating the laundry facilities, possibly to a outhouse. Abbey Care Home DS0000053550.V296807.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. This section achieves a quality rating of ‘good’. This judgement is backed by the consistently positive comments made about the caring attitude of the staff. Both the advisors, and acting manager have said that the strength of the home is the quality of the care team and ancillary staff. Most have achieved or are doing the main NVQ qualifications. There has also been a significant increase in training arranged by the advisors. Much more careful vetting procedures are now followed. EVIDENCE: 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. The only change has been that the lead senior on each shift remains on duty for 15 minutes to do a hand-over to the oncoming staff. Of the sixteen care staff, seven are seniors who act as ‘shift leaders.’ There is a chef everyday between 8am and 2pm, and a domestic assistant six days a week between 8am and 1.30pm. Last year the inspector found that the then manager and the owner were failing to carry out adequate checks on staff. One of the advisors has completed an audit of staff files to make sure the required vetting had been carried out, and that supporting documents were authentic. He has met with each staff member to go through their details. He has shown the inspector his Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 21 checklist confirming that CRB certificates have been obtained through Havering Care Association. ‘PovaFirst’ clearance is received before a staff member can commence work under supervision. The samples of staff files seen at this visit were satisfactory. All staff have been issued with a contract, and a copy of the ‘staff handbook’. Staff files have copies of their induction programme; training profile and copies of certificate and proof of identity; and a recent appraisal. The inspector met with a group of six staff. One comment was – “We now have a good working relationship with management and we interact well….we feel more included. There is much more training, we have had quite a lot of training in a short time.” This has included medication, manual handling, food hygiene, first aid, health and safety and fire, infection control, and adult protection. There has also been a course on bereavement. They confirmed that they had all been given a copy of the General Social Care Council’s code of practice. Nine staff have achieved NVQ Level 2, of which five have moved onto Level 3. Currently, five staff are doing Level 2, with a further two due to start. This means that the target of having 50 qualified staff has been achieved. Abbey Care Home DS0000053550.V296807.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. The general conclusion under these headings is that the quality rating is now ‘good’. However, this judgement is based on the evidence provided by the advisors and acting manager covering recent improvements. The importance of maintaining this level of accountability is highly dependant on having a competent manager in day-to- day charge. EVIDENCE: The acting manager who started in last December confirmed that she will not be remaining at the home. She has offered to continue in post for a couple of months while a replacement is recruited. The two consultant advisors have agreed to extend their period of involvement, but will be spending less time at the home. The top priority for the owner is to recruit a competent manager to maintain and carry forward the reforms that have been introduced over the last five months. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 23 A major concern to emerge from the 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. The previous manager had also failed to keep others informed, including delays in telling residents’ families when an accident or incident had happened. 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. 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. The advisors are carrying out a comparative analysis of considerably fewer accidents that have occurred since they started. 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. In addition to the initial audits carried out by the advisors, they have introduced other monitoring systems. An initial staff survey was circulated in February, but only four were returned. This has been followed by an ‘anonymous’ questionnaire, resulting in a much better return. As was the case in the inspector’s discussion with staff, they are keen to see solutions to space problems. In particular, they are asking for staff changing facilities, one comment being – “As you can see, staff take a pride in their appearance and keeping their uniforms smart. We really need a room so we can get changed, and we should have a staff toilet.” Another person added – “Yes, if we could wish for something it would be more space. There is a problem storage.” Helpfully, there is a plan to create a small staff changing room by relocating the food storeroom. A residents and relatives survey has also been completed. The results are set out in the revised ‘Residents’ Handbook’, largely showing a high level of satisfaction. A follow-up survey is ready to be sent out. There is also satisfaction survey form ready to be used following new resident move ins. The advisors have been asked by the owner to do the ‘monthly reports.’ Copies of these should be sent to the Commission. The presentation of records at inspections is much improved, and the inspector said that he appreciated this efficiency. This included the ordered way health and safety documents are arranged. At this visit all the certificates and records Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 24 were satisfactory, including those covering in-house fire safety checks and contractors’ maintenance visits; safety of gas and electrical systems and appliances and the water supply, and other equipment such as the call-system and hoist. There have been recent visits by a fire safety inspector and an environmental health inspector, both of whom report satisfactory arrangements. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 2 2 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 3 3 3 Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes – Item 1 is carried over from the last report. 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 OP31 OP32 Regulation 8; 9 Requirement Provide an application to register a manager. (This item is re-notified, the original compliance date was 30/04/06) Develop a plan to provide residents with social and recreational activities appropriate to their abilities and interests. This should include consideration of individuals’ religious and cultural affiliations. Consider ways to assist residents maintain links with the local community, including opportunities for going out. Monitor the standard of catering, including ensuring adequate variety and quality of stocks. Consider ways to improve the communal facilities, and keep the Commission informed of any works such as the addition of the proposed conservatory. As appropriate, keep under review the appropriateness of aids and adaptations to ensure they meet the current assessed needs of residents – such as the DS0000053550.V296807.R01.S.doc Timescale for action 14/08/06 2. OP12 16(2)(n) 17/07/06 3. OP13 16(2)(m) 17/07/06 4. 5. OP15 OP20 16(2)(i) 23 17/07/06 17/07/06 6. OP22 23(2)(n) 17/07/06 Abbey Care Home Version 5.2 Page 27 7. OP24 16(2)(c) 8. OP33 26 suitability of bathing facilities. Have a plan covering the refurbishment of bedrooms. This should aim to provide furniture and equipment as set out in Standard 24.2. Where applicable, redecoration should take into account the choices of service users. Provide the Commission with copies of the ‘monthly visit reports’ carried out by the registered owner or a representative. 17/07/06 17/07/06 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 OP26 Good Practice Recommendations Review the laundry facilities, and consider ways of increasing working space. Abbey Care Home DS0000053550.V296807.R01.S.doc Version 5.2 Page 28 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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