Inspection on 14/08/08 for Abbey Grange Nursing & Residential Care Home

This inspection was carried out on 14th August 2008.

CSCI found this care home to be providing an Good 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 Nursing &... 14/08/07

Abbey Grange Nursing &... 26/10/06

Abbey Grange Nursing &... 31/01/06

Abbey Grange Nursing &... 07/06/05

Abbey Grange Nursing &... 08/03/05

Abbey Grange Nursing &... 20/04/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Abbey Grange Nursing & Residential Care Home 61 South Road Weston Super Mare North Somerset BS23 2LT Lead Inspector Jon Clarke Unannounced Inspection 14th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbey Grange Nursing & Residential Care Home Address 61 South Road Weston Super Mare North Somerset BS23 2LT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01934 623223 01934 414024 enquiries@manor-court.co.uk Manor Court Care Homes Ltd Manager post vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (3) of places Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. May accommodate up to 38 persons aged 65 years and over, requiring nursing care. May accommodate up to 7 persons aged 65 years and over, requiring personal care. Staffing Notice dated 21/12/2000 applies Manager must be RN on Parts 1 or 12 of the NMC Register May accommodate up to 2 persons in the Cedar Lodge Annex who are aged 18-64 years and have a Mental Disorder. May accommodate up to 3 persons between 18 - 64 years of age with physical disabilities, requiring nursing care. May accommodate one person aged 50 years and over. One named Service User, aged 44 on admission, this condition will cease when named service user leaves the home. 14th August 2007 Date of last inspection Brief Description of the Service: Manor Court Care Homes Ltd owns Abbey Grange. Abbey Grange offers a total of 40 places. The main home provides predominantly nursing care for older people, although up to 8 service users who require personal care only may be accommodated. Cedar Lodge is a small self-contained unit, which provides personal care for 2 people, aged between 18 and 64 years, who have a mental disorder. In addition, the home offers day care to older people. The day care unit is housed within the main home, but has designated facilities and a separate staff team. Abbey Grange is a converted and extended older property on the hillside of Weston Super Mare. Many rooms enjoy panoramic views over the town, and there is an attractive garden to the front of the building. A passenger lift provides easy access to all areas of the home. Accommodation is provided in 27 single, and 6 double rooms. Eight of these have en suite facilities. The company is in the process of upgrading the accommodation. The communal areas of the home have been refurbished and redecorated to a high standard. The current fees range from £369.34 to £545.86 per week. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of an inspection. A number of documents were looked at including care plans, pre-admission assessments, staff records relating to recruitment and training. There was also an opportunity to talk with individuals who live in the home and staff about their experience of living and working in the home. A number of Have Your Say questionnaire were sent to the home before this inspection however we only received one response from a staff member and one from a health professional a disappointing response. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: What has improved since the last inspection? Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 6 A number of requirements were made at the last inspection and these were looked at on this visit and it was established they had been met. This has resulted in improvements in care planning. 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. The summary of this inspection report can be made available in other formats on request. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of pre-admission assessments were seen however the home has introduced a new format but we did not see any that had been completed using this new form. Local authority assessments had been obtained and the home visits individuals where possible to undertake their assessment. The new Pre-Admission Assessment is very comprehensive and will provide extensive information about the care needs of the individual and importantly provide a real picture of the person and their social needs ie social contacts, leisure pursuits. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 9 The home has introduced a Residents Handbook A Quick Reference Guide to Our Services. This is in large print and is to be given to all individuals when they come into the home. It provides full information about the facilities available as well as arrangements around visiting, meals, activities, community services (chiropody, dental), staffing and qualifications. In the inspectors view this will certainly enable individuals and their representatives to be fully informed about the quality of care provided in the home. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and showed clear and detailed information about the care needs and associated tasks of the individual. Included were care and diet charts (one individual was receiving puree diet and this had been recorded daily) and personal care records. Reviews had been held on a regular basis, monthly or bi-monthly. There was evidence of the individual’s involvement in the completion of their care plan and this was confirmed by those with spoke with on the day of this visit.. Where necessary Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 11 the home completes fluid and skin care charts. Risk assessments had been completed relating to falls, skin care, as had moving and handling assessments. Where bed rails are in use to safeguard individual’s consent had been given by the individual or their representative. The home has good links with local health services and individuals have access to local optician, chiropody and dentist. Individuals told us that they “always can see a doctor when I want”, “the matron is very good at getting the doctor if I need to see him”. For one individual the home has been working with the local Disability Adults Resource Team and the Palliative Care Team. They have also adopted “an end of life integrated care pathway” and work closely with the hospice where this service is needed. The home has also prepared a booklet with advice for families and relatives when they experience bereavement. A health professional who responded to the Have Your Say questionnaire stated when asked what the service does well: “shows respect to individuals. You get the impression that staff want to give the best possible care whilst preserving privacy and they treat people with respect. Staff have been receptive to our advice and offers of training”. Medication administering records were seen and had been completed as required with no gaps in recording. Controlled drugs register was completed as required and checks of medication showed that records of stock were accurate. Storage arrangements are secure and satisfactory. There were no individuals managing their own medication. In talking with individuals who live in the home they all spoke positively of the approach of staff and that they felt they were treated “as I would want”. One individual said they felt “staff always treat me with respect I have no complaints about them”. Staff were observed throughout the visit supporting and assisting individuals in a sensitive and supportive manner. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: In talking with individuals who live in the home about the activities available they spoke of how they “enjoyed the trips out”, “there’s always something I can do”, “there’s enough for me”. The home employs an activities organiser for 2 days a week. Activities arranged include: flexercise, outside entertainers, board games and local trips out. The activities organiser told the inspector how she has spoken to individuals and recorded their likes and dislikes, social interests and information about their personal history. At present this is not recorded in the individuals care plan doing so would make this information Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 13 more accessible and improve the quality of care plans. This was discussed with the acting manager at the time of this visit. Individuals we spoke with said how they felt their visitors were always made to feel welcome and did not feel there were “any restrictions on who and when we have visitors”. A relative had commented, “all we ever experienced was smiles, welcome and cheerfulness”. We spoke with individuals who live in the home about how they spend their time and whether they felt they had the freedom and choice in how they spent their day. Individuals said they felt “it was up to me what I do”, “its all very relaxed here”. We asked one individual about getting up and going to bed and whether they could choose the time this happened they said “its always up to me”. This was also discussed with a member of staff and they said “its up to them it’s their home”. When asked about meals individuals we spoke with said they “always enjoyed the food”, “there’s always a choice”, “they know what I like and don’t like which is good”. The meal on the day of our visit was well presented and menus showed a wide variation of meals offered in the home. During the mealtime staff were available and gave assistance where needed in a supported and unobtrusive way. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: The home has received one complaint since the last inspection. This had been responded too in a satisfactory way and within the homes complaint’s procedure timescales. We spoke with a number of individuals who live in the home about what they would do if they were unhappy about anything all responded that they would speak to the manager or a member of staff. Importantly individuals spoke of believing they would be “listened to and something done about it”. Individuals said they found staff approachable “we can always speak to them about anything” was one comment made. We spoke to a number of staff about their understanding of Adult Abuse they were able to give examples of what would constitute abuse: not giving personal care when it was needed particularly when dealing with personal hygiene, refusing to take people to the toilet when needed. We felt they had a Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 15 good understanding of the issues around abuse and were confident that they would report any concerns they had. Staff have received training in Adult Protection though there remain a number that have not done so the inspector was informed that further training was planned for in September. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In walking around the home and looking at maintenance records it was evident that the home maintains a good standard of decoration. The home has been over the past years been extensively decorated and facilities updated. In the last year the home has installed a shower room, redecorated a number of rooms, two bathrooms, third floor corridor and landings. Individuals we spoke with said that they “always” found the home clean and “its all very comfortable and nice”. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 17 The home has infection control procedure in place and staff are provided with the necessary equipment. Staff have received infection control training. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing rotas were looked at for a period of four weeks and showed that adequate staffing with generally 5 on am (with 8-8) and 4 pm plus Registered Nurse on duty at all times. Individuals we spoke with said they felt staff “are available when we need them” “there’s always someone around” “help is there when I need it”. One staff member said they felt the “staffing level is right” and “we have time to sit with people”. Staffing recruitment records showed that all the required checks had taken place with two references, Criminal Record checks, POVA. Application forms had been fully completed with detailed employment history. Training records showed that staff had completed the required “mandatory” training: moving and handling, health and safety, Adult Protection and fire Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 19 training. There were gaps in Adult Protection training but these are being addressed. Staff we spoke with confirmed they had received training in these “mandatory” areas and one said how they were “very pleased with the training provided”. Senior staff have received training in the Mental Capacity Act.There was also evidence that staff had received formal induction. The activities organiser had not received any training in this area and in the inspector’s view this would be of benefit. No staff had received generalised training relating to working with Older People. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. EVIDENCE: Currently there is no Registered manager for this service with an acting manager. This was discussed with the owner of the home at the time of this visit and it is hoped this will be resolved at the earliest opportunity. However in talking with staff they felt well supported by the acting manager and individuals who live in the home found management approachable. At the time of this visit the home’s lift was out of action. Action had been taken to maintain as far as possible normal routines with some individuals with their Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 21 permission being moved to other rooms. It was noted that staff were working particularly hard to make sure that the disruption had little as possible impact on the daily lives of individuals and this is to be commended. Records relating to health and safety were examined. They showed that the required checks of the fire system take place with regular services of equipment. Fire Risk assessment has been completed. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 30 X 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP30 Good Practice Recommendations Staff to receive t training relating to care of older people of a more generalised nature such as Parkinson’s, Strokes, Mental Health Awareness. Abbey Grange Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nursing & Residential Care Home DS0000020225.V367121.R01.S.doc Version 5.2 Page 25 - 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!