Inspection on 09/02/09 for Abbey Dean

This inspection was carried out on 9th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abbey Dean 22/05/09

Abbey Dean 21/05/09

Abbey Dean 03/06/08

Abbey Dean 26/05/06

Abbey Dean 04/01/06

Abbey Dean 19/07/05

Abbey Dean 07/02/05

Abbey Dean 02/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey Dean 102 Barnham Road Barnham Chichester West Sussex PO22 0EW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Val Sevier     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Abbey Dean 102 Barnham Road Barnham Chichester West Sussex PO22 0EW 01243554535 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr David Geoffrey Dean,Mrs Laramie Dean Name of registered manager (if applicable) Mrs Laramie Dean Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Abbey Dean is registered to provide personal care for up to fourteen people over the age of sixty-five years (category OP). The building is semi-detached and the accommodation is provided on the ground and first floor. The accommodation is single rooms that have en-suite facilities with a toilet and hand basin. A passenger lift is provided to the first floor. There is a lounge, conservatory and dining room on the Care Homes for Older People Page 4 of 33 care home 14 Over 65 14 0 Brief description of the care home ground floor. There are well kept gardens with lawns and walkways that are accessible. Mr and Mrs Dean own Abbey Dean. Mrs Dean is the registered manager responsible for the day-to-day management of the establishment. The fees for the home at the time of the visit were #495 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service 0 star. This means the people that use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assurance Assessment (AQAA) completed by the home from 2008, and an unannounced visit to the home, which was carried out on the 9th February 2009, during which we were able to have discussions with staff and have interaction with some people who use the service. Care Homes for Older People Page 6 of 33 A pharmacy inspector also visited the home on the 13th February 2009 to look at medication administration, storage and records. Their findings are included in this report. During the visit we looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and people who use the service, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. We also sent several surveys for completion by those that use the service and other professionals, at the time of writing this report nine surveys have been returned. The registered manager and provider Mrs Dean was not available on the day of the visit, we were assisted with our visit by the staff and administrator. Requirements for action made from the last inspection visit in June 2008 have not been fully met further action is being considered outside of this report. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must detail the care and support needs for individuals where support has been identified so that staff are aware what they need to do for people who live at the home. Where there is concern about the safety and welfare of an individual risk assessments must be carried out and there must be a record of action to be taken to minimise the risk for people who live at the home as far as possible. The safety of medicines must be observed at all times. Documented evidence of actions around medicines need to be completed and in more detail. The home has obtained criminal record checks for all staff that did not have them at our last visit and for new staff who have been appointed. However the records showed that checks were not in place before the staff member started work. Care Homes for Older People Page 8 of 33 Staff must receive training in mandatory areas such as moving and handling, health and safety, food hygiene and first aid. Documents such as records of accidents must be stored in line with the Data Protection Act 1998. Staff must receive regular training in fire safety to protect those people that live at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. The current assessment record would prove more beneficial to the assessment and care plan process for the individual if the information is used as a basis for the care plan to meet identified needs. Evidence: The last AQAA we received from the stated that: We make them feel happy and secure. We have an up to date service user guide, new clients have a full assessment and care plan. They can agree a trial period. We have updated our service user guide to include statement of purpose as well as all other relevant information. It was seen in the how we have improved in the last twelve months, that the home has updated the service user guide to include statement of purpose as well as all other relevant Care Homes for Older People Page 11 of 33 Evidence: information. Mrs Dean the registered manager carries out the assessment and when people move in they are given an information pack related to them and the room they are moving into. We looked at two assessments that had been done since our last visit, one person who now lives at the home permanently and another who has come to the home for respite. The assessment includes the following areas a contact names sheet, personal details, medical details, for example doctor and health issues, social information for example previous occupation, children and social history, allergies and next of kin. There are also several risk assessments for example falls, nutrition and moving and handling. For one we saw that it had not been completed in every section and had not been signed and dated. With the other assessment we also saw a discharge letter from the hospital this had recent medical issues and history of needs. There were areas on the homes assessment form for this individual left blank, for example medical history and allergies. Others had brief information for example personal care and washing needs help. In our surveys we ask two questions related to moving to the home, Have you received a contract? and Did you receive enough information about this home before you moved in, so that you could decide if it was the right place for you? Of the nine we received back six had ticked yes they had received contracts, one had not answered and two had ticked no with comments, It is pending and Do we need one. What would be in it? Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records and systems within the home do not always ensure that the personal and healthcare needs of people who use the service are met safely and effectively. People who use the service are at risk regarding the administration of medication with records not being maintained and no clear evidence of medication changes. Staff working practise helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA in 2008 told us that: Every client has an individual personal health and psycho-social needs plan. We respond pro actively to any changes. They pursue many diverse leisure interests. They have a choice of health and dental care. We take them to all appointments in our own Mini-bus. Care Homes for Older People Page 13 of 33 Evidence: There were concerns following our last visit to the home in areas such as care plans, risk assessments and medication administration and recording. At this visit we were looking for evidence of how the manager and staff had actioned and continued to work to meet the requirements we had made from our last visit. We sampled four care plans of people who use the service, two of whom had moved to the home since the last visit. The care plans sampled were being used in conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals. The home uses the Roper model of care planning which lists nine areas that can be looked at: maintaining a safe environment and administration of medication, personal care and dressing, skin, elimination, sleeping, eating and drinking, communicating, cognitive ability and relationships. The home has two systems for keeping records of daily events for individuals. One a weekly sheet where dates and signatures can be added and areas such as no new problems, care as plan, new problem identified, seen by GP or separate isolated incidents or events can be circled. The reader of the file would be directed to another sheet of paper as indicated. On the ones we saw they were not all dated, most were signed, there were no extra comments or indication to look at another sheet of paper. The other daily report sheet had information about staff intervention and support. There was not a record every day. For individual one, we saw that a care plan and associated risks had been identified of pressure sores and falls. The longterm goal was to prevent the complications due to reduced mobility such as falls and pressure sores - to keep mobile. We saw that other plans of care were not signed or dated. We saw other risks assessments for general activities, falls, nutrition, physical health, mental health, behaviours and pressure sores. All appeared to score low and no further written action for staff to take. The medication care plan for this individual states that they are on oxygen for breathing difficulties. We could not see a plan of care for this or instructions for staff other than; is on O2 for COPD needs for approx 15 hrs per day 6pm to 9am. We spoke to staff about this and they said that the oxygen cylinder is in the persons room but not used. There is a converter that takes the surrounding air in and filters it for the individual, which is then delivered to them via a nasal tube. For individual two, we saw a form titled; Is your resident at risk of falls? with ten questions any of which if circled indicated a risk. This individual had scored 7 out of 10. There was no plan in place to reduce the identified risks. It was seen on daily report sheets that the individual had accidents resulting in skin flaps and skin tears. Again there was no evidence that there was action for staff to take to lessen or Care Homes for Older People Page 14 of 33 Evidence: prevent these risks. In September 2009 notes stated that; a strong odour was present in a wound and Aquacel AG applied. There was no evidence that a care professional that specialises in wounds and tissue viability had been contacted. When we spoke to staff they said that the manager had advised this course of treatment. We saw that there was one wound progress chart, which related to a tear on the shin in August 2008 and to the daily records. We could not see a progress record for the wound on the right leg and elbow. We looked at another care plan where an individual had wounds and pressure areas. We found that there was no consistency in information and wound progress charts were not clear. One instruction for a skin flap injury stated; to change dressings every 3 - 5 days, we saw dates with a record of progress, which ranged between 5 and 10 days. We saw that the last risk assessment for this individual was dated 2005. On the 3rd November 2008 we saw that a specimen had been sent for testing for possible infection. There was no evidence that this had been followed through by staff. We saw that another specimen had been taken on 6th February 2009. We spoke to staff about this, as there was no evidence that this had been followed through. Staff stated that the results had come back on the day of our visit and antibiotics had been prescribed. This was not recorded until we asked about it. On January 21st 2009 we saw in the daily notes that this individual had been removed from the dining room twice in one day as they had become agitated. We did not see a plan of care related to behaviour or interventions to be made by staff. The risk assessments we saw for this individual were dated 2006, when all areas of risk were assessed as low. We saw that the third individual had seen a dentist and had had new dentures fitted since moving to the home last year, however the care plan said that teeth didnt fit and for food to be liquidised. We spoke to staff about this and they said that the individual did have new teeth and that they did not have all food liquidised most food was cut up small and if needed the meat was liquidised. We saw that this individual had swollen ankles, action had been taken by the home for example elevating the foot of the bed there was no risk assessment for this action. The last record in the daily record sheet of 13th January 2009 stated no improvement GP informed. There did not appear to be any follow up. Staff told us that this person had come from a nursing home and had not been very mobile and had not been able to use the bathroom. Since moving to the home staff had worked with them to help with mobility and managing going to the bathroom. There was no record of how the person had been and the improvement and change in care to facilitate and support this improvement. Care Homes for Older People Page 15 of 33 Evidence: For the fourth individual on the GP visit record sheet we saw an entry on the 4th December 2008, which we could not read at all, this had been written by the manager. Staff also did not know what it said when we asked them to read it. We could not find any corresponding date or information on the daily record sheet. On the daily record sheet on 19th January 2009 there was a record written by the manager again which said; Tx SRH f/u re bladder Px. This again was not clear to staff we spoke to on the day. We saw that this individual had had a routine hospital appointment on 6th October 2008 the next entry dated 30th October stated appointment first chemo, then 13th November third chemo. There was no record of a second appointment or when the last appointment was. There was no plan of care or written record of why this individual was having chemotherapy. We spoke to staff who said that the last appointment had been 9th December, and that they had a leaflet about the chemotherapy, they were verbally able to tell us why this person was having treatment. We were able to speak with two staff members and we asked about the care plans and information that they had about the needs of individuals who live at the home. They commented that they knew about peoples needs and information was given verbally or was in the care plans. Staff were observed speaking and assisting individuals with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. The medication storage, records and administration were looked at under a separate visit by the pharmacy inspector on 13th February 2009. Medicines are locked in a wooden cupboard within a room. There is no provision to store controlled drugs according to the requirements of the law. Medicines requiring cool storage are kept in the domestic fridge. We observed at lunchtime the medicine were left in the dinning room for the person to take with their lunch and at the time no member of staff was in the room. There were other people sitting at the dinning table for their lunch. These medicines were not safe. Medicines were received in a multi dose system that had no indication for identification of medicines. There was one such multi compartment filled with four white tablets, which would be difficult to identify. If any medicines were to be omitted for any reason the staff would not be able to identify it to do so. Medicines requiring additional special instructions were followed. We viewed all medicine administration charts and a couple from the previous month. The records of Care Homes for Older People Page 16 of 33 Evidence: when medicines were to be used were not sufficient in detail to reflect exactly the situation. For example when a medicine was to be given as a variable amount the actual amount given was not recorded and for one person a medicine was changed from one twice a day to one once a day. There was no documented evidence in the notes to say where this authorisation came from. Many examples were seen where medicine prescribed for only when needed did not have clear guidelines for staff to follow to give this and therefore there would not be a consistent manner in its use. Many examples were seen where changes to instruction on the chart were not initialled and cross referenced to further detailed notes. People are able to manage their own if they wish to however there are no risk assessments in the care plan for this. Requirements were made following our last visit to the home for action regarding care plans, risk assessments and medication administration and records. We found that the evidence did not support that these requirements had been met and further action is being considered. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home in 2008 stated that: We have beetle drives, musical afternoons, craft and arts afternoons which many choose to join in or not. Visitors are always welcome and offered suitable refreshment. Meals are varied and new menus often tried, clients are invited to feed back and to contribute to choices of meals. Flexible routines to fit all clients. They are encouraged to maintain religious or day clubs and outside social activities. They are encouraged to maintain family contact. Since our visit last year a member of staff has been employed at the home three times a week to support individuals with activities. One comment on the events for February on the notice board said M available for help. We saw that the hairdresser comes weekly on a Wednesday. Communion is held monthly in the lounge. There was bingo on the 6th February and six dates when external entertainers were booked to come Care Homes for Older People Page 18 of 33 Evidence: into the home. We saw that a mini bus trip was planned for the 13th weather permitting or keep fit in the lounge if the weather was bad. There is no menu for people to choose from however, we saw staff ask individuals what they would like for supper. We saw in the diary a record of the meals served and saw that there were several choices prepared for example: chicken salad, pizza and salad, cheese and biscuits and egg and bacon. We also saw the breakfast list where breakfast for individuals range between toast, grapefruit, squash, Ryvita, cereals, bananas, cranberry and prunes. There was no evidence of other meals being cooked at lunchtime there seemed to be one thing cooked, although staff said that there were alternatives given. We looked at the rota while we at the home and spoke with staff and there were two care staff on duty on the day of the visit from 2pm. They were responsible for care, the management of the home and preparing, cooking and serving 13 suppers. In our surveys we ask; Are there activities arranged by the home that you can take part in? and Do you like the meals at the home? With regard to the activities, the survey responses told us that five always take part, two usually and one sometimes there were two comments, Mini bus ride and music afternoon, and My disability means there are only certain activities I can take part in. In those we received in relation to the meals, eight said that they always liked the meals one said they were satisfactory with a comment I think there is an improvement. We saw on two care plans that individuals had bath days this included weekends. Staff said that this could be changed. We did see for one individual detail of how they like to present themselves to others, what jewellery they like to wear, and what they can do for themselves. We also saw instructions for staff under communication, keep bell near, careful explanation of where they are and what is happening and what is required of them, needs consistency. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The homes complaints procedure was seen to be available in the information given to people who use the service. There have been no complaints received by the commission. The home promotes an open door approach to relatives and people who use the service, to help resolve complaints and issues effectively. The home uses the West Sussex Safeguarding Adults policy and staff were seen to have training in adult protection as part of their induction as well as yearly updates. There has been one safeguarding referral made since our last visit, which is currently being investigated at the time of writing the report. The AQAA in 2008 for the home stated that: We have a formal complaints procedure, we have a complaints record book. All staff are trained in preventing elderly abuse. We have a whistle blowing policy. We saw on staff files we sampled that training had taken place last year in Care Homes for Older People Page 20 of 33 Evidence: safeguarding adults using a DVD and questionnaire. Staff we spoke with said that they would report anything they were unhappy with to the owners. We asked if there was a difficulty at that level where would they go, some said they would seek guidance outside of the home from social services or the commission. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. Evidence: We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures, to make it feel like home. Abbey Dean is situated in its own large, well kept grounds. The home was seen to be very clean throughout, we noted a strong malodour on entering the home along the main corridor, when we walked around the home later there was an odour of freshening spray. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The Care Homes for Older People Page 22 of 33 Evidence: AQAA for the home in 2008 stated: Abbey Dean is very clean and safe and well maintained indoors and outside. The garden is designed to enable clients to walk a circuit in safety. There are seats in appropriate areas, providing sun and shade. Clients rooms are personalised and arranged to suit their needs. All rooms are ensuite. Specialist equipment is quickly accessed should it be required. Clients are able to control the temperature of their rooms by individual thermostatic valves. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Monitoring systems do not ensure sufficient numbers of staff are trained to care for residents and are on every shift. Recruitment practises do not protect people who use the service. Staff have not received the mandatory training that is expected each year, and it is not clear that staff have received training to meet all the needs of people who use the service and placing people at risk. Evidence: The staffing structure at the home consists of the owners, one of whom is the registered manager, support workers, kitchen staff, and housekeeping. There are two night staff one awake and one asleep. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. On the day of our visit there were two care staff, a cook, two domestic staff, and a laundress who worked 10 till 2 and the administrator. The rotas indicated that the domestics work three days a week for four hours; the laundress also works three days a week. When these staff are not at work the care staff carry out these duties in addition to their care work. Care staff prepare and serve breakfast and supper. One member of staff has been employed to assist with Care Homes for Older People Page 24 of 33 Evidence: entertainment or offer additional support for four hours on Monday, Wednesday and Friday. We looked at six staff files to see what training staff had undertaken and how they had been recruited by the home. We saw that for three staff they had begun work before checks had been completed or received at the home. There were no separate POVA first checks carried out only those included with the Criminal Records Bureau (CRB) checks, which were dated after the staff member had commenced work, one member of staff only had one reference which was also dated after they had stared work, on one file a reference was there but not dated and the other was dated after the staff member had begun work. We saw that only one of these three staff had had an induction. We could not see any evidence that these staff had received mandatory training in health and safety and moving and handling. We saw that six staff had had supervision three times since our last visit. On the other three staff files we saw that two staff had received training using a DVD and questions and answers on moving and handling, safe guarding adults, food hygiene and medication since our last visit. We saw that the moving and handling training was overdue for updating. The AQAA for the home in 2008 stated that: The staff who work the most hours are either NVQ or a trained nurse. All staff require two references and CRB check before they work. All have a supervised induction shift. We are, in the mornings, at least one staff member above the requirement. It was seen in the fire records book that 7 of the 16 staff members had had a quiz about fire safety on 14th April 2008 at the staff meeting. The remaining staff last had training in fire safety in October and November 2007. We saw that new staff had been given fire instruction and that a full evacuation had been undertaken in July 2008. However, we could not see that other staff had received fire training twice yearly. We spoke with staff on the day and they said they had undertaken a fire questionnaire sometime in the two weeks prior to our visit. Following our last visit to the home a requirement was made regarding the recruitment practices by the home. The evidence did not show that this requirement had been met and further action is being considered. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of sufficient management controls and systems for risk assessments and information in the care plans; current medication administration and recording and recruitment practices, place people who use the service at risk. Evidence: There were concerns and requirements for action made following our last visit, in areas such as care planning, risk assessments, medication, recruitment and training of staff, were made. These requirements for action have not been met and these issues will be dealt with separately. The manager Mrs Dean is a nurse although she is not employed as a nurse at the home, which provides personal care. She also has a Masters Degree in Business Studies. She has been managing the service at Abbey Dean since the home opened in 1991. Mrs Dean also works one day a week at the local GP surgery. Mrs Dean was away on the day of our visit. Care Homes for Older People Page 26 of 33 Evidence: The AQAA for 2008 stated that: Regular training and supervision takes place. Staff are motivated and loyal protecting the health and welfare of clients. Our administration has regard and sensitivity for probity. Residents families find our financial system sound. We have employed a very experienced NVQ3 trained carer who is efficient, clients feel safe and less experienced staff feel supported. We have developed a more efficient petty cash system. Surveys returned to us had some additional comments about the home: I am content here. Home from home. The best decision we ever made was to move here, no more worries. At the last visit the home had no formal quality assurance monitoring system in place. We saw that a questionnaire had been returned to the home between August and October 2008 with comments in some cases for example: Staff are kind and do their best to keep the clients and visitors happy. One form not dated said; would like more salads and regular nightly checks, a comment from the home said to be addressed by key worker. There were a range of written policies and procedures available for staff to refer to as guidance and to inform their practice. These included the following: Admission, discharge and transfer of residents Human Rights; Confidentiality and access to personal records; Abuse of the person; Drug administration; Self administration of medication; Infection control; Complaints procedure; Whistle blowing; Sexuality and Health and safety at work. We were unable to check any records regarding personal monies. At the previous visit there had been gaps in the record keeping regarding accidents. We saw that the home has an accident book that is designed to comply with the Data Protection Act 1998. We saw that completed records are still in the book, the book is designed to protect confidentiality, the records must be removed and stored separately. There were 29 records in the book the last dated 4th February 2009 with a fall out of bed for an individual who sustained carpet burns. We could not see that any action had been taken to look at this incident and prevent or lessen re occurrence. As noted in the staff in the staffing section of the report we could not see any evidence that staff had undertaken fire training every six months. We did see that the fire system had been checked two or three times a month not weekly as the homes fire book states fire equipment and lighting have been checked regularly. Other equipment at the home has been checked monthly for example wheelchairs, bath seats and first aid boxes. Care Homes for Older People Page 27 of 33 Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Sch 3 (1)(b) People who use the service must have clear individual care plans describing the support that staff give to meet identified needs 01/07/2008 2 8 13 (4) (b)(c) Where it has been identified 01/07/2008 that people who use the service are at risk from falls, a risk assessment must be put in place to lessen those risks. Medication administration 01/07/2008 records must show what medication has been a given or state reason why it has been omitted. A thorough recruitment of staff must include, CRB and POVA First checks to protect people who use the service. 01/07/2008 3 9 13 (2) 4 29 19 Sch 2 (5)(6)(7) 5 38 23 (4) (d) All staff must receive regular 01/07/2008 fire safety training. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 15 Sch 3 (1)(b)People who use the service must have clear individual care plans describing the support that staff give to meet identified needs. to ensuer that staf are arware of what and how to meet individual needs 03/03/2009 2 8 13 13 (1) (b) 03/03/2009 Where it has been identified that people who use the service are at risk from falls, and or there are behavioural issues, and or moving and handling needs, a risk assessment must be put in place to lessen those risks and professional healthcare advice where indicated. To ensure the safety and well being of peole who live at the home. Care Homes for Older People Page 30 of 33 3 9 13 13 (2) The registered manager must obtain a correct specification controlled drugs cupboard To comply with the law 13/04/2009 4 9 13 13 (2) The registered manager must ensure that there is a detailed risk assessment for any medicines that are self managed by people in the home. To protect the health and welfare of residents 28/03/2009 5 9 13 13 (2) The registered manager must ensure that there is a care plan for individuals where medicines are prescribed to be taken only when needed. So that the medicine is used in a consistent manner 20/03/2009 6 9 13 13 (2) The registered manager must ensure that there is clear documented evidence for medicine doses that are changed indicating who authorised this change. To have a picture of the treatment history and ensure medical input is followed in actions taken. 20/03/2009 Care Homes for Older People Page 31 of 33 7 29 19 19 Sch 2 (5)(6)(7) A thorough recruitment of staff must include, CRB and POVA First checks to protect people who use the service. To protect people living at the home 03/03/2009 8 30 13 13 (3) (4) (5) The registered person must be able to demonstrate through risk assessment that qualified first aid staff are on duty at all times as described in the CSCI policy guidance: First Aiders To protect staff and people who live at the home. 09/03/2009 9 38 23 23 (d) The registered manager must ensure that there are records kept of fire training. So that the home can monitor satff training in fire safety to protect those that live at the home. 09/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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