Inspection on 24/02/09 for Abbey Grange

This inspection was carried out on 24th 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 Grange 16/11/09

Abbey Grange 14/10/09

Abbey Grange 06/08/09

Abbey Grange 20/05/09

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 21/06/05

Abbey Grange 15/10/04

Abbey Grange 23/07/04

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

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT zero star poor service 02/10/2008 The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Denise Reynolds Date: 2 4 0 2 2 0 0 9 Information about the care home Name of care home: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT 01432271519 01432271519 ubheedave@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Aileen Ubhee,Mr Bissessur Ubhee care home 29 Number of places (if applicable): Under 65 Over 65 29 29 29 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 29 29 0 29 All residents must be at least 50 years of age on admission. That Mr Ubhee works a minimum of 30 hours a week at Abbey Grange in order to fulfil his responsibilities as the Care Manager. Date of last inspection Brief description of the care home 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 local buses pass within easy reach. The original part of the premises has been adapted for its current use. It carries Care Homes for Older People Page 2 of 14 0 2 1 0 2 0 0 8 Brief description of the care home a listed building status. This places some restriction for making desired alterations. The original building has been extended to provide additional, purpose-built accommodation. The home is registered to provide care to 29 people who are over 50 years of age and who have needs arising from old age, dementia or mental disorder. Information about the service is displayed in the main entrance hall of the home. A copy of the most recent inspection report is also displayed. A schedule of fees is available from the home. Additional charges are made for hairdressing, transport, escort, chiropody, toiletries and newspapers. Care Homes for Older People Page 3 of 14 What we found: We did this inspection to check what action the owner had taken to deal with the requirements we made after we inspected the home on 2nd October 2008. The owner/manager (Mr Ubhee) sent us an Improvement Plan which arrived in advance of the due date. The contents indicated that Mr Ubhee believed that things at the home are satisfactory or being improved. However, the plan lacked detail and made general statements rather than giving us clear details of what Mr Ubhee intends to do to improve the service. In advance of planning another full inspection we have asked Mr Ubhee to send us a new Annual Quality Assurance assessment (AQAA), this is a document that care services are required by law to fill in and send to us each year. They have to use the AQAA to tell us what they are doing well, what they need to improve and how they are going to do this. At the end of this random inspection we stressed to Mr Ubhee the importance of filling the AQAA in with sufficient details about what he is doing to improve things at Abbey Grange. This report is set out using the topics of requirements from the last report as headings. Because we found that some requirements from the last key inspection had not been met we have issued statutory requirement notices. This is because we have concerns that people living at the home may be put at risk or not have their needs attended to correctly. We will check what the owners have done to put things right when we do our next inspection. If we then find further breaches of the regulations about the same things we may decide to take further formal action. What the care home does well: What they could do better: REVIEWING AND AMENDING ASSESSMENTS We found that information about reviews of assessments for peoples care was unclear. This was partly because the information about care needs was not always written on the page related to the topic in question. For example a persons needs in respect of diet and MRSA were written on a care plan headed Breathing. We also found examples of reviews planned for 17th February but there was no information to show that these reviews had been done. We found contradictory information about a persons moving and handling needs with two forms completed over the same period of time but with one indicating the person had low level needs while the other showed the person to have very high level needs in this respect. We have dealt with the Care Homes for Older People Page 4 of 14 concerns we had about assessments in a new requirement and a statutory requirement notice about about care plans. DETAIL IN THE WRITTEN INFORMATION ABOUT CARE (CARE PLANS) We found the information written down about the care people need was not detailed enough to give staff the information they need to provide the right care. For example, the care information about the dementia related needs of a person did not give staff guidance about how they need to help the person when they become distressed and agitated. The records show that the person often has disagreements with other people in the home but again, there was no guidance to staff about how to reduce the chance of this happening or what to do when it does. In another example, there was no care plan to tell staff how they should help a person with their catheter correctly and no details of the precautions staff should take when assisting a person with MRSA. We have issued a statutory requirement notice about care plans. CONSULTING PEOPLE ABOUT ACTIVITIES We were shown information about five activities that have been introduced at the home. Each person living at the home had been asked which of these activities they either did or did not wish to take part in. Lists had then been made to show which people would take part in which activities. Our requirement to consult people about activities had therefore been met, although the outcome was not the one we were hoping for. We had expected that the manager of the home would have approached this by asking people in the home about their choice of activities and looked at ways to provide these, rather than introducing a small set activity plan which may not be to all tastes. The approach taken by the manager is not one that values each person as an individual and we would want to see much more being done to focus on the preferences of each person. We have made a new recommendation about this. INFORMING PEOPLE ABOUT THE OUTCOME OF THEIR COMPLAINTS No new complaints had been made to the home since we made this requirement. We noted that the information about complaints referred to by the manager in his recent Improvement Plan was not ready to be given to people who might need a copy. We are making a new recommendation about making sure that copies of the procedure are readily available and that staff are trained to know what to do if someone speaks to them about making a complaint. ENSURING THAT STAFF TAKE PRECAUTIONS AGAINST THE SPREAD OF INFECTION We saw a lot of things that concerned us about infection control in the home. These included empty hand cleanser dispensers, toilets and bathrooms without liquid soap and paper towels, untidy bathrooms and toilets with items such as hairbrushes left on shelves and the lids of toilet cisterns and numerous toilet rolls not on holders. We also saw tubs of creams with no names on in bathrooms and toilets indicating that staff use the cream for more than one person; this is very poor practice. We spoke to a member of staff who acknowledged not wearing a disposable apron to empty a catheter. As well as creating infection control risks, these things are also an indication of the lack of Care Homes for Older People Page 5 of 14 effective management at the home. We have issued a statutory requirement notice about this. THE CHECKS DONE ON NEW STAFF TO MAKE SURE THEY ARE SUITABLE We found that the correct staff recruitment checks are not being done for staff. This increases the possibility of unsuitable staff gaining employment at the home. In the three staff files we looked at, important information, such as proof of identity, references and/or criminal records bureau checks had not been obtained by the home. Mr Ubhee had accepted criminal records bureau checks from previous employers for two of these people. He should not have done this because the integral protection of vulnerable adults check is not transferable from one employer to another. The law says that home owners and managers must do correct checks before new staff start work and by not doing so Mr Ubhee could put people living in the home at risk. We have issued a statutory requirement notice about this. STAFF KNOWLEDGE AND SKILLS Information available in the home about staff training is not well organised and makes it difficult to check which staff have done training and when. We saw that some new training is in hand, for example, two staff have started a distance learning course in dementia care and other staff are doing distance learning in infection control. We will review the progress being made in staff training when we do our next key inspection. We have made a recommendation that the manager improves the staff training information at the home so that it provides a more effective tool for planning and monitoring staff training needs. A particular area of staff training that we are concerned about is dementia care. This is because the home has registration to allow it to admit people with dementia related care needs. However, only two staff staff have done training in this topic and two more have started a distance learning course. We consider it is essential for more staff to do training in this subject if the home plans to offer care of this type. We have made a new requirement about this. COMPETENCE OF STAFF LEFT IN CHARGE WHEN THE MANAGER IS NOT AT THE HOME The information about the training done by senior staff was unclear and this made it difficult for us to confirm whether all the staff who might be left in charge of the home have the knowledge and experience required to take this level of responsibility. We will be looking at this again when we do our key inspection. We are concerned that the manager works all his hours in blocks of time that mean he is away from the home for several days at a time. Our observations and findings from this inspection increased our concerns that the home is not effectively managed. STAFF TRAINING ABOUT PROTECTING PEOPLE FROM ABUSE Half the staff group had recently done training with Herefordshire Council about this subject and the other half were booked to do a course in March. This requirement was therefore met. If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 6 of 14 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 14 You must ensure that care 31/12/2008 plans are sufficiently detailed and include accurate information about peoples care needs. To ensure that staff know the care that is required and are able to provide the right care. 2 9 13 You must ensure that 31/12/2008 medication is stored securely and safely, and that equipment used for the administration of medication is kept clean. This is so that the people who use the service are not put at risk of harm. 3 26 13 You must ensure that staff take precautions which will limit the chance of infection spreading. This is so that people who live at the home are not at risk of harm from infection. 31/12/2008 4 29 19 You must ensure that all the information specified in this Regulation is secured to determine the fitness of employees working at the home. 31/12/2008 Care Homes for Older People Page 8 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This will help to prevent unsuitable staff being employed. Care Homes for Older People Page 9 of 14 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, 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 15 You must review care plans 10/04/2009 and where necessary update plans to reflect changing needs and current objectives for health an personal care. This is to make sure that people continue to receive the correct care when their needs change. We have issued a statutory notice about this. 2 7 15 You must ensure that each service user has a written care plan that sets out in detail the assessments and subsequent action which needs to be taken by care staff to ensure that all aspects of the health and personal care needs of the service user are met at all times. To make sure that staff have the information they need to give people living in the home the correct care. 10/04/2009 Care Homes for Older People Page 10 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 AND To make sure that people living in the home have their individual needs met. We have issued a statutory notice about this. 3 26 13 You must ensure that 06/04/2009 suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection at the care home. This is to help make sure that people living in the home are protected from infection. We have issued a statutory notice about this. 4 29 19 Where people are employed 27/03/2009 to work at the home with a POVA 1st check ensure that appropriate arrangements are put in place to ensure that they work in accordance with Regulation 19(11) of the Care Homes Regulations 2001. To help protect people living in the home from unsuitable staff being employed. We have issued a statutory notice about this. 5 29 19 You must ensure that in respect of all people employed at the care home all relevant information and 27/03/2009 Care Homes for Older People Page 11 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 documents as required by Regulation 19 of the Care Homes Regulations 2001 is sought and available for inspection. To help protect people living in the home from unsuitable staff being employed. We have issued a statutory notice about this. 6 30 18 Regulation 18(1) All staff providing personal care to people living in the home must receive training which gives them the knowledge they need to work with people who have dementia related care needs. The training must be sourced and booked by the timescale stated. This is so that staff can improve their knoweldge of the needs of people who have dementia and develop a better understanding of what is considered good care practice in this type of care. 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 13/04/2009 1 15 People living in the home should be helped to spend their time doing things which they have chosen themselves, rather than being offered only set activities that limit the Page 12 of 14 Care Homes for Older People 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 choice they have. 2 16 You should ensure that copies of the complaints procedure are readily available and that staff are trained to know what to do if someone speaks to them about making a complaint. You need to improve the staff training records so that they provide clear information about the last date each person did each type of training. You should also have clear information available about who training was provided by and details of the training given. Without this information it is not possible to monitor the ongoing staff training programme or the training needs of individual staff. You should do a training needs analysis for each member of staff and for the staff team overall; this would help you to plan a realistic annual training programme and budget. 3 30 4 30 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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