Inspection on 21/06/05 for Abbey Grange

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Grange 16/11/09

Abbey Grange 14/10/09

Abbey Grange 06/08/09

Abbey Grange 20/05/09

Abbey Grange 24/02/09

Abbey Grange 02/10/08

Abbey Grange 11/03/08

Abbey Grange 10/10/07

Abbey Grange 23/10/06

Abbey Grange 18/10/05

Abbey Grange 15/10/04

Abbey Grange 23/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Abbey Grange 47 Venns Lane, Hereford HR1 1DT Lead Inspector Wendy Barrett Announced 21 June 2005 9:30 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 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 Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Abbey Grange Address 47 Venns Lane, Hereford, HR1 1DT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01432 271519 01432 271519 Mr & Mrs Ubhee Care Home 21 Category(ies) of Old People 21 registration, with number Physical Disability over 65 years - 10 of places Dementia over 65 years - 2 Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Physical disability over 65years of age - 10 places Dementia care over 65years of age - 2 places Date of last inspection 15th October 2004 Brief Description of the Service: Abbey Grange is situated in a residential area on the outskirts of Hereford city. There is a drive-in parking area at the front of the home and a lawned garden area to the side. The original part of the premises has been adapted for its current use. It carries a listed building status. This presents some restriction for making desired alterations e.g. replacement of existing entrance porch. A purpose built extension was permitted and this has increased the bedroom and utility facilities at the home. There are seventeen single bedrooms. Thirteen of these have en suite facilities. There are two double bedrooms. The Commission has recently approved the use of a single room to accommodate a married couple who wished to move into the home together. There is a local bus route within reach of the home. A stair lift is installed and ramps, rails and non-slip flooring have been fitted to help residents who have mobility problems. Two lounges are accessed from the main entrance hall and there is a separate dining room. The home is registered to accommodate 21 older people who have needs arising from the normal ageing process. Ten of these places are also registered for older people who have a physical disability. Two places are registered for older people who have needs relating to a dementia illness. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that was undertaken between the hours of 9.30am and 4.30pm. The Provider was present at the home. Feedback questionnaires were sent for all staff employed at the home prior to the inspection. Two responses were received. A care assistant was formally interviewed about their experience at the home and a Senior Care assistant assisted with the inspection of care records and medication management. Other staff e.g. cook/care assistant were met as they went about their work in the home. The recently admitted married couple were interviewed in the privacy of their bedroom. A resident and visiting relative also spent some time talking about their views of the service. Other residents were briefly met in the communal lounges and observations made of daily activities taking place through the day. The Provider assisted with the inspection of various records and documentation. The main focus of the visit was reviewing action taken to comply with previous inspection requirements. Some of these related to an inspection by the Commission’s Pharmacy Inspector on 27th September 2004. There was also attention to National Minimum Standards that had not been recently inspected. What the service does well: People who are considering whether they want to be admitted have a chance to meet the Provider in their own home. Relatives are encouraged to help prospective residents tell the staff about themselves and this information is written down so that staff will know what the new resident wants and needs. When residents have falls or other accidents the circumstances are investigated to try and stop it happening again. When residents become unwell the staff are competent to recognise this and to know when they need to ask for more guidance from other health care specialists. New staff are carefully vetted by the Provider before they are offered a job. This helps to protect vulnerable people from contact with unsuitable individuals. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 6 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 Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 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 standard(s) 3 Residents do not move into the home without having care needs assessed and receiving assurance that these will be met. EVIDENCE: There was a detailed report of a pre-admission visit by the Provider to the home of the married couple. There was also a written report from the daughter of the couple offering additional information about their needs and lifestyle. An initial care plan was seen with a contribution written in by the daughter regarding personal care needs. The married couple spoke about their daughter’s ongoing consultation with the Provider and staff and her continuing involvement in their care during the initial period of their residence at the home. Both staff feedback responses indicated that they were given enough information to be able to do the job properly. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9, 10 Residents health and personal care needs are met. These are set out in an individual plan of care. Residents can choose to manage their own medication if they are able to do so safely. Staff need to regularly check that the situation hasnt changed. Residents are protected by the homes policies and procedures with dealing with medication although staff must make sure they adhere to these at all times. EVIDENCE: Visual observations of residents indicated good support with personal care and laundry care. The lady residents were enjoying having their hair done. A care record included a care plan for the provision of a softened diet as a result of an oesophageal constriction. There was also a plan written by a relative for regular massaging of legs to aid better circulation. There were no residents reported to have pressure sores. There was an example seen of use of a pressure-relieving mattress as a preventive measure. A resident mentioned arrangements made by her daughter to attend to a hearing difficulty. A staff member was familiar with procedures for infection control and the provision of protective disposables. The staff member also referred to recent Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 10 training in dementia care, first aid and manual handling. The care plan of the only resident who self-administers medication included a risk assessment and consent form. The risk assessment had not been reviewed since February 2004. This should be done as part of any routine review of the care plan. The security of the main stock cupboard for medication had been reinforced since the Pharmacy Inspector’s inspection. Although there were no controlled drugs in use at the time of this inspection, a lockable cupboard within the main stock cupboard was provided. This will need to be fixed before it needs to be put in use. The medication administration records were inspected with the assistance of the Provider and Senior Care Assistant. They described how the information recorded on each sheet enabled them to maintain an audit trail for all drugs kept in the home. There were records of receipt and disposal as part of this trail. There was a discrepancy in instructions recorded on a MAR sheet and a record of actual administration. One tablet was being administered twice daily although the written instruction (inaccurately) referred to two tablets to be given at night. The Pharmacy Inspector offered an explanation why it was not acceptable to use pre-printed labels on the MAR (Medication Administration Record)chart. This explanation was given to the Provider over the phone after the current inspection once clarification had been sought. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 14 and 15 Residents are able to continue with their preferred lifestyle when they come into the home. Relatives are able to maintain contact according to the residents wishes. The meals are good and satisfy the residents. EVIDENCE: There were examples of a variety of social activities e.g. a resident was going out with her daughter dancing on the afternoon of the inspection, a group of ladies were playing dominoes, staff were sitting with a group of residents who were knitting squares to make blankets. Some residents preferred to spend time quietly in their own rooms. A staff member was observed inviting a resident to have a shower and accepting the resident’s preference not to take up this opportunity. Another staff member was observed consulting residents about their preferred choice of tea time meal. This was done sensitively and patiently to ensure the residents weren’t pressurised into making a hasty choice. Menus for the day were displayed out in the home. Residents all expressed satisfaction with the variety and quality of food offered. A particular need for a softened diet was being addressed with attention to attractive presentation. Residents felt that the Provider and staff were available and approachable. A resident was able to name the staff member she felt able to talk to about any Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 12 problems. An independent advocate has started to visit the home and meet with residents. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18 Staff are given guidance to make sure residents are protected from abuse. EVIDENCE: The Provider has supplied the Commission with a copy of an Adult Protection/Whistleblowing policy. Staff had access to a copy of these documents and were aware of their relevance. The Commission has not received any complaints about the service since the last inspection. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20 and 26 Residents live in a well maintained, clean and pleasant home with attention given to hygiene and safety factors. There are a few facilities that need to be improved to make them fully suitable for the residents. EVIDENCE: There were examples of the Provider’s ongoing investment to improve the presentation and safety of the residents’ accommodation e.g. new carpeting throughout all corridors, stairways and lounges, new washable, non-slip floor covering for the dining area. Two bedrooms had also been fitted with new carpet and decorated since the last inspection. A resident commented on the benefits of the ’nosing’ fitted to the stairs. Fire safety arrangements had been improved with additional magnetic door holders and new wooden boarding on floors to stop smoke coming through. The premises were clean, tidy and odour free. There were fresh flower arrangements in communal areas. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 15 The current sluice and bathing facilities would benefit from upgrading, and the siting of the staff station in a public area does not provide confidentiality. These shortfalls may be difficult to address in the current premises but should be given priority if any extension to the accommodation is proposed for the future. The provider has supplied the Commission with a copy of an Infection Control policy and procedure. A staff member was familiar with this guidance literature and confirmed that disposable gloves and aprons are available. There is not yet a machine sluice facility. Soiled waste is disposed of by special contract with the local authority. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Residents needs are met but sometimes this is difficult for the number of staff available to maintain. There are recruitment policies and procedures that protect residents. Staff receive training but there needs to be more involvement in obtaining nationally recognised qualifications to ensure their overall competence to do their job. EVIDENCE: The standard duty rota reflected a satisfactory level of staff and this was supported in staff comments. There were also comments suggesting a difficulty in maintaining adequate staff cover during periods of annual leave/sickness. One comment suggested that staff are required to work on their days off to maintain a satisfactory level of staff. Another comment referred to the particular difficulties when extended periods of leave were authorised. The Commission has been supplied with a copy of the home’s recruitment policy. This is satisfactory and covers the necessary vetting procedures e.g. Criminal Records Bureau (CRB) checks. An interviewed care assistant had attended a number of recent training sessions e.g. dementia care, fire safety, health and safety, first aid and manual handling. He had not undertaken NVQ level 2. Two staff were working on an NVQ award. Although other staff had been assessed by Coventry University personnel for participation in an NVQ scheme there had been no further development. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 36, 37 and 38 The Providers are competent to manage the home properly and residents benefit from their combined contribution. Staff are appropriately supervised. Residents are generally safeguarded by the homes record keeping and policies and procedures although some confidential records need to be stored more securely. The health, safety and welfare of residents are promoted and protected. This work would be strengthened with some additional routine auditing of safety aspects through the building. EVIDENCE: One of the Providers has applied to the Commission for registration as the Care Manager. He has increased his attendance at the home in order to oversee everyday care. There is evidence of improvements to record keeping, care practices and the stability of the staff group since this time. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 18 A care assistant felt that both Providers are approachable and listen to staff views. These can be shared at monthly meetings. The care assistant felt that the staff group are working better as a team. This is also indicated in the increased stability of the staff group with few changes of people employed. Individual staff are supervised and supported through a structured programme of supervision. They have a named supervisor and meet regularly. The Provider responded to a request by the Commission for a sample of policies and procedures. These were supplied prior to the inspection and covered areas of recruitment, infection control and adult protection/whistleblowing. The content was satisfactory. Staff at the home had a policy and procedures file for reference, and they were able to demonstrate their awareness of the material available in the file. Some records are not securely stored to ensure confidentiality. The Commission is receiving notifications of events at the home as required under Regulation 37. There are good examples of risk assessing falls etc. There is reference in this report to work undertaken by the Provider to improve the safety of the premises e.g. fire safety improvements. The fire log contained records of routine servicing of fire safety equipment and fire drills. The electrical installation was last inspected in November 2000. This is within the recommended timescale. Portable appliances are inspected by an outside contractor and the Provider has a machine to test appliances in-house. The work completed by the Provider indicates that premises risks are being identified and addressed. However, the situation would be improved with the introduction of a recorded system of regular health and safety audit of the premises. A staff member mentioned recent health and safety training e.g. manual handling, first aid. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 x x x 3 2 2 Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement Printed labels must not be used on MAR sheets. Additions/changes to medication must be handwritten by authorised staff and checked by a second authorised staff member. Both staff should sign the MAR sheet. (The Provider was advised of this requirement by telephone after the inspection and following further consultation with the Commissions Pharmacy Inspector) The guidelines from the Royal Pharmaceutical Society of Great Britain (paragraph 6.2.2.) to be followed with regard to the administration of medicines in food and the crushing or opening of tablets or capsules. (carried forward with revised timescale. Not reviewed this time) A system of reviewing and improving the quality of care provided at the home must be introduced. This should include consultation with residents and their representatives. A report Timescale for action Immediate and ongoing 2. 9 13(2) 31st July 2005 3. 4. 33 24 31st August 2005 Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 21 5. 30 18 6. 19 23 in respect of any review should be supplied to the Commission and made available to residents. (carried forward with revised timescale. Not reviewed this time). Induction and foundation training must be in line with National Training Organsiation specifications. (carried forward with revised timescale. Not reviewed this time). Any future proposals for extending the premises must address improvements to bathing, sluice and staff station facilities. Training provision must be developed to increase staff participation in the NVQ award scheme. Staff must be consulted about the adequacy of relief cover arrangements. 31st August 2005 7. 30 28 Within any future application for registration variation. 31st December 2005 Commissio n to be informed of the outcome of consultatio n and any action planned as a result by 31st August 2005 8. 27 18(1)a 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 9 Good Practice Recommendations To review the effectiveness of current practice regarding review of self administration risk assessments and checking of accuracy of handwritten information written into MAR sheets by staff. E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 22 Abbey Grange 2. 38 To introduce a programme of regular, recorded audits of premsies health and safety aspects. Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Hereford Area Office, 178 Widemarsh Street, Hereford HR4 9HN 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. Extracts may not be used or reproduced without the express permission of CSCI Abbey Grange E52 - E02 S24689 Abbey Grange V230504 210605 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!