Inspection on 24/05/07 for Abbey House

This inspection was carried out on 24th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Abbey House Abbey House 455 Hill Cross Avenue Morden Surrey SM4 4BZ Lead Inspector Liz O`Reilly Unannounced Inspection 10:30 24th May 2007 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 House DS0000068551.V340478.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 House DS0000068551.V340478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbey House Address Abbey House 455 Hill Cross Avenue Morden Surrey SM4 4BZ 020 8542 5065 020 8542 5065 s.abbeyhouse_455@hotmail.co.uk 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) Sivanithy Krishnabala Sivanithy Krishnabala Care Home 5 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (3) Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A The service has recently been taken over by new owners. Brief Description of the Service: Abbey House is a registered care home providing accommodation and care for up to five older people, two of whom may have mental health needs. Mr and Mrs Krishnabala are the Registered Providers. The building is a three storey converted domestic property with two single bedrooms on the ground floor and three single bedrooms on the first floor for residents use. The top floor of the home is staff accommodation. The home is located in a residential area of Morden close to local shops, pubs and public transport. Current range of fees for this home are £380 - £450 per week. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection of the home since the new owners took over in December 2006. The inspection was carried out by one regulation inspector and consisted of a visit to the home, discussion with people who use the service, staff and the owner/manager. Questionnaires were left for residents and staff and sent to visitors after the visit to the home. Judgements made in this report are based on all of the evidence gathered from these sources and observations made during the visit to the home. What the service does well: What has improved since the last inspection? What they could do better: To make sure that the needs of people who use the service are known staff must take care to make sure that care plans are up to date with any changes recorded. All documents must be signed and dated. To assist in ensuring the safety of residents a full employment history must be provided by staff before they start work in the home. If a prospective member of staff was working in a care home or service before Abbey House then the Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 6 manager must get written verification from their previous employer as to why they left. Staff should be provided with training in dementia care. Risk assessments must be carried out on the unguarded radiators in the home. It is recommended that radiators are fitted with covers or changed to low surface temperature type. To ensure that sufficient staff are always on duty the manager must ensure that a record of any incidents during the night is kept. It is recommended that all residents, relatives and regular visitors to the home are reminded of the complaints procedure. 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 House DS0000068551.V340478.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 House DS0000068551.V340478.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): 1, 2 & 3 People who use this service receive good quality outcomes in this area. Evidence suggests that prospective people who use the service have a needs assessment carried out before they are admitted to the home. The service has developed a Statement of Purpose and Service User Guide which provides basic information about the service the home offers. Each person is provided with an individual contract. EVIDENCE: Before anyone is admitted to the home assessments of their individual needs are carried out by staff from the home. Those people who are placed through the local authority have an care management assessment carried out and this is made available to staff at the home. These assessments make sure that staff are aware of and can meet the needs of each individual. The pre admission assessments also provide information from which staff can prepare an initial care plan for use when the resident moves in. Everyone who uses the service is supplied with a copy of the Service User Guide which gives them information on what they can expect from the home. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 9 People considering moving in can also be supplied with a copy of this document. All residents are given a contract which sets out the terms and conditions of occupancy including the fees. The contracts in place are those provided by the previous owner. The present owners should make sure that these contracts remain valid now that they have taken over the home. Abbey House DS0000068551.V340478.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 People who use this service receive adequate quality in this outcome area. Each person has a care plan which staff have improved by making them more individualised. Risk assessments are completed but do not evidence when or by whom they were completed. Where limitations on individuals movements are in place evidence that this has been agreed with the individual and their representatives is not available. The health care needs of residents are met and medication is well managed. EVIDENCE: The new manager has made a good start with up dating and improving care plans to make them more person centred. Good information has been included on the likes, dislikes and emotional support required by individuals. Staff are provided with good details of what is important for individuals, what they like to do, what is essential for them and in what areas they need support. Care must be taken to make sure that the plans are up to date and that information is consistent throughout. We found that changes had occurred for individuals but that the care plans did not reflect this. Where goals were for encouraging independence this needed to be followed through in the care planning on actions for staff. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 11 Records indicated that reviews of the care plan had taken place but these need to result in alterations to the plan if there have been any changes. Individual risk assessments are in place but were not all signed and dated. To make sure that these are accurate, up to date and agreed these need to be signed, dated and reviewed on a regular basis. All residents are registered with local GP We found evidence that staff support residents to attend health care check ups and appointments. Arrangements will be made for district nurses to visit the home if necessary. Medication is well managed and safely stored. Abbey House DS0000068551.V340478.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 People who use this service receive adequate quality in this outcome area. Staff are working on promoting independence for individual residents and this is reflected in some of the care planning. Information on the likes and dislikes of individuals has been recorded. Staff are also working to improve the social and community activities for individuals. EVIDENCE: The new management are keen to improve the individual activities for people who use the service. Arrangements have been made for one person to receive additional staffing hours to offer support for day time activities. This has resulted in improvements in this persons independence and social life. Staff are recording activities in the daily record but need to make sure that the care planning is up to date and matches the activity programme for each individual. Staff have taken care to include the preferences of people in the documentation including cultural, emotional, social and religious wishes. This information can then be used to offer individuals the opportunity to take part in activities which suit them. People who use the service told us that they are supported to keep in touch with family or friends and that they can have visitors whenever they wished. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 13 They also said that they enjoyed the company of other residents and staff and were happy with the activities arranged. Since the new owners have taken over certain residents felt that they were more involved in the day to day activities around the home. The home owners are looking to improve the social aspect of daily life by providing more personalised activities and offering more variety over the next twelve months. At a recent residents meeting the offer of a holiday was discussed. Meals are prepared in the domestic style kitchen and snacks are available at any time should someone get hungry. Residents who wish to do so are supported to make their own snacks and drinks. People who use the service told us that they enjoyed the food provided. Abbey House DS0000068551.V340478.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 People who use the service experience adequate quality outcomes in this area. The home has a complaints procedure and systems in place for recording any concerns raised. However not everyone was aware of how they should go about making a complaint. Policies and procedures for safeguarding people are in place and staff have been provided with training on the protection of adults. EVIDENCE: Records showed no complaints being received since the new owners took over the home. Systems are in place for the recording of any concern along with actions taken and outcomes. The feedback we received about the complaints procedure from people who use the service and relatives or friends indicated that not everyone was aware of the procedure. We recommend that all residents and their relatives or regular visitors are supplied with another copy of the procedure. Staff have been provided with training on safeguarding adults. This makes sure that they can recognise abusive behaviour and are aware of their responsibilities to report any concerns they may have or may be reported to them. The home keeps a copy of the local authority procedure for safeguarding adults which provides information on who should be contacted should there be any concerns. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 15 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 People who use this service experience good quality outcomes in this area. Since taking over the home the new owners have carried out a significant amount of redecoration and repair. People who use the service were happy with the environment. The home is well lit, clean and tidy. EVIDENCE: Improvements have been made in a number of areas of the home with redecoration, new electrical wiring, a new television and new pictures on the walls. The manager informed us that new carpeting had been ordered for the whole home and plans were in place to purchase new dining chairs. The garden area has been returfed and plans are in place to repair the garden pond. Further redecoration was planned for areas which had been disturbed by the new wiring. Radiators in this home are not covered and a risk assessment must be carried out to ensure the safety of residents. It is recommended that radiator covers or low surface temperature radiators are installed. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 16 Residents told us that they were happy with the environment and that it was always kept clean and tidy. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 17 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 People who use this service receive adequate quality outcomes in this area. There are enough staff on duty to meet the present needs of people who use the service. Opportunities are being made available for staff to attend training to improve their skills and knowledge. Further training to meet the needs of people with dementia would improve the service. Staff have a clear understanding of their roles and responsibilities. More care needs to be taken to make sure that all proper checks are carried out before someone starts working in the home. People who use the service are generally very happy with the approach and attitude of the staff. EVIDENCE: Residents gave very positive feedback about the staff group. They felt they were well care for. Staff spoken to, who have started working the home this year, have completed training on first aid, food hygiene and safeguarding adults. The were planning on commencing NVQ training in September of this year. A minimum of two staff are on duty during the day. One member of staff is asleep on the premises at night and can call on the manager if needed. The manager is aware that the staffing levels particularly at night must be kept under review and increased should the needs of individual residents change. The home must keep a record of all incidents where the person sleeping in is called out. This record must include the reason for the call out, the actions taken and the length of time working during the night. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 18 Examination of staff records showed that Criminal Records Bureau Checks are being carried out before staff start work in the home. The records need to be up dated to include a full employment history and if the person previously worked with vulnerable adults, written verification as to why they left this job. References must be sent from Abbey House to the named persons and returned before the staff member starts work. A statement by staff on their physical and mental health must also be kept on file. These checks will assist in ensuring the safety of residents. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 19 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, 33, 35 & 38 People who use this service experience adequate quality outcomes in this area. The manager has the necessary experience to run the home. Consultation with residents takes place on a daily basis informally and in more formal residents meetings. The manager is aware of the need to promote safety for residents, staff and visitors to the home. Checks show that records are generally up to date. Regular checks by the manager should be made on money held in the home for residents. EVIDENCE: The new manager has made good progress on consulting with people who use the service and in developing the quality assurance systems which will feed into an annual review of the care provided and development plan for the home. Good progress has also been made by the manager in introducing a more person centred care planning and activities programme. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 20 Regular health and safety checks are carried out. As noted previously risk assessments need to be carried out on the unguarded radiators around the home. Facilities are available for residents to deposit small amounts of money in the home for safekeeping. A record of all money in and out of individual accounts is kept. It is recommended that the manager make regular checks on these accounts to ensure that they are up to date, accurate and signed by all those involved in a transaction. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP7 Regulation Requirement Timescale for action 01/08/07 2 OP19 OP38 3 OP29 15, 14, 12 In order to make sure that the needs and wishes of individuals are known and met care plans must be kept up to date. To evidence consultation and review of care planning and assessments all documents must be signed and dated. 13(4) To ensure the safety of 01/08/07 residents, risk assessments must be carried out on the unguarded radiators around the home. 19 To safeguard the people who use 01/08/07 Schedule the service the following 2 information must be obtained and kept before any new staff commence work in the home: • A full employment history with a satisfactory written explanation of any gaps in employment. • Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why they ceased to work in that position. • A statement by the DS0000068551.V340478.R01.S.doc Version 5.2 Abbey House Page 23 4 OP27 18 member of staff as to their mental and physical health. • Two written references sought directly by the home manager. To make sure that sufficient staff are available in the home to meet the needs of the resident group a record of all incidents which take place at night must be kept. 01/08/07 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 2 3 4 Refer to Standard OP16 OP19 OP38 OP30 OP35 Good Practice Recommendations People who use the service, their families and regular visitors to the home should be reminded of who they should approach if they have any complaints or concerns. It is recommended that action is taken to protect residents from the risk of burns from unguarded radiators. To make sure that staff have the skills and knowledge to meet the needs of the people who use the service staff should be provided with training on dementia care. To make sure that records are up to date and accurate it is recommended that the manager make regular checks on the individual finance records for residents. Abbey House DS0000068551.V340478.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 House DS0000068551.V340478.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. 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