CARE HOMES FOR OLDER PEOPLE
Abbey House 20 - 22 Albert Road Bexhill on Sea East Sussex TN40 1DG Lead Inspector
Mike Flint Key Unannounced Inspection 26th September 2006 09:50 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 DS0000048567.V312849.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 DS0000048567.V312849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abbey House Address 20 - 22 Albert Road Bexhill on Sea East Sussex TN40 1DG 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) 01424 222534 www.angelhealthcare.co.uk Angel Healthcare Limited Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users should be aged 65 (sixty five) years or over on admission. The maximum number of service users to be accommodated is 23 (twenty three). Only older people who have been assessed as requiring residential care are to be accommodated. 28th November 2005 Date of last inspection Brief Description of the Service: Abbey House is a well-maintained, large detached Victorian property situated in the centre of Bexhill-on-Sea in East Sussex. The shops, transport and Bexhill seafront are all within easy walking distance from the home. The interior of the house has been extensively refurbished to provide a pleasing and comfortable environment for up to twenty-three older people. Residents accommodation is all in single rooms, provided on three floors, with level access via a passenger lift. The residents private garden at the rear of the premises is well maintained. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of the home was carried out over five hours, during a day in late September, when there were fourteen older people in residence. On duty were the acting manager, who assisted throughout the inspection, the deputy manager, two carers, the cook and the handyman. During the visit the Inspector spoke with each of the staff and three of the residents in their private rooms. The Inspector was pleased to join residents for their midday meal. As part of the evidence gathering process for this inspection and to assess the overall performance of the home, the Older Persons Care and Assessment Team at Social Services was contacted for comment. Written comments were received from nine of the residents, in response to the postal questionnaires sent out by the Commission, prior to the site visit. The fees for residential care at Abbey House are currently £339.00 to £425.00 per week. Extras provided such as newspapers, hairdresser, chiropodist, transport, toiletries are at additional cost. What the service does well: What has improved since the last inspection?
There has been a positive response by the home to the requirements and recommendations, made at the time of the last inspection, carried out in November 2005; most of these had been met, or are being worked towards: five of the staff are commencing NVQ training; an application has been submitted to the Commission for the registration of the acting manager; care staff are receiving 1:1 supervisions with the acting manager; and the required safety devices are in process of being fitted to windows, where wide openings and low sills may pose significant risk to residents of falls. The Inspector was shown some of the vacant rooms, which had been tastefully redecorated, as had the exterior of the building. New lounge furniture has been provided and the kitchen fittings up-graded, since the last inspection.
Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 6 One of the existing care staff has accepted additional responsibilities as activities co-ordinator. The Inspector was told of the two summer, garden parties that had been held and were well attended by friends and families; the residents said they had enjoyed these occasions. From the monies raised, the acting manager said that a fish tank is to be purchased for the residents’ enjoyment. A suitable system of care planning and risk assessment is now in place that ensures continuity of care for each resident; the acting manager said that key workers would be identified, in some cases depending on individual circumstances and level of need. Personal profiles have been recorded that provide staff with helpful information about each resident’s history. The acting manager indicated that further improvements to the home’s care planning methodology are on-going. A new form of pre-admission assessment has been introduced; particular attention is being paid to ensuring that the home is able to meet the needs of the people admitted. The acting manager has introduced suitable induction training for new staff and has also established regular consultation with residents, their families and staff for their views on the services provided, using feed-back questionnaires, where appropriate, or one-to-one discussions. 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 House DS0000048567.V312849.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 DS0000048567.V312849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good; the home has procedures in place to ensure that the needs and expectations of those admitted can be met. The home has a pleasantly relaxed and friendly atmosphere that contributes towards the well-being of the residents. These judgements have been made using available evidence including visits to the home. EVIDENCE: Documentary evidence showed that satisfactory pre-admission assessments are completed for all those, referred to the home, ensuring the suitability of the placement. Residents spoken with said that visits to the home had been arranged to assist them in reaching their decision about moving in. Residents commented that they felt their needs were being well met. Staff were observed responding attentively and showing respect towards residents. The home does not admit persons requiring intermediate care, or accept emergency admissions. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good; personal support in the home is offered in such a way as to promote and protect the residents’ privacy, dignity and independence. This judgement has been made using available evidence including visits to the home. EVIDENCE: A satisfactory system of care planning and risk assessment is in place. Daily progress notes are entered for each resident by duty staff; actual times, when night-time checks take place, are recorded. Care-plan reviews involve the resident together with their next-of-kin, where this is appropriate and has been agreed. Residents spoken with commented favourably about the quality of care provided by staff. The acting manager said that Abbey House receives good support from the Community Healthcare Services through well-established links. The administration of medicines in the home is satisfactory promoting good health. Staff spoken with said that only residents, who were assessed as competent, would have responsibility for self-medication, and that only staff who have received training in this aspect of their work are responsible for
Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 10 administering medicines. The record sheets of medicines provided evidence of consistent good practice, in this respect. administered Interactions between staff and residents, observed during the inspection, were friendly and respectful e.g. when entering residents’ private rooms, or when attending to residents needs. The Inspector noted that time and attention was given to individual residents in a supportive and caring way. It was apparent that residents benefited from the 1:1 interactions with staff; the acting manager confirmed that this informal aspect of the care provided contributed positively to the residents’ sense of well-being. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good; the home provides a relaxed and supportive environment that enables residents to pursue their interests and autonomy within a socially orientated setting that is beneficial to their wellbeing. The meals in this home are of a good quality, offering both choice and variety, catering for any special dietary needs. These judgements have been made using available evidence including visits to the home. EVIDENCE: Some form of activity is provided on most days for the interest of those residents, who wish to participate. The residents spoken with mentioned in particular their enjoyment of Tai Chi and were appreciative of the efforts made by staff in support of their interests, including trips out to the seafront and local shops. The Inspector considered that the support and encouragement given to residents, who wished to pursue their own interests, was appropriate. The Inspector was told that the local church provided a monthly communion service at Abbey House. It was apparent, during the inspection, that the routines of daily living are flexible to suit the residents’ needs e.g. bedtimes, taking meals in their private rooms, entertaining visitors, or attending to interests outside the home. One of the residents attends a local day centre; others have regular contact with
Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 12 family and friends. Visitors are welcome to the home at any reasonable time. Each of the residents spoken with commented very favourably about daily life in the home. At staff suggestion, the acting manager is making arrangements for the hire of a mini-bus to provide outings for residents, from time to time. The Inspector was shown menu plans, which appeared to provide an appealing, nutritious and well-balanced diet. Daily mealtime choices are discussed with residents and records are kept of all meals served. Residents spoken with commented positively about the quality and choices of the meals. The home employs qualified cooks throughout the week. The meal served on the day of the inspection was hot, tasty and nicely presented. It was apparent to the Inspector that much care is taken over the dining room service. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 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 the following standard(s): 16 and 17 Quality in this outcome area is good; any matters of concern are handled appropriately, reassuring those involved that they are being listened to and that action will be taken, as necessary. Staff receive training in the protection of vulnerable adults, minimising potential risks to residents’ safety and well-being. These judgements have been made using available evidence including a visit to the home. EVIDENCE: There have been no complaints recorded since the last inspection, or matters of concern brought to the attention of the Commission. Abbey House has a written procedure that advises residents, or visitors to the home how to make a complaint. Residents said that they felt the staff and the acting manager were very approachable and responsive, should any issues arise. The home has policies and procedures in place relating to the protection of vulnerable adults and adult abuse; the acting manager confirmed that all staff receive training in this area of their work. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 Quality in this outcome area is good; the home provides a pleasant environment that is accessible and satisfactorily maintained, meeting residents’ individual and collective needs in a comfortable, homely style. These judgements have been made using available evidence including a visit to the service. EVIDENCE: The layout and location of the home is well suited for its purpose and satisfactorily maintained by the employed handyman. There is a small, private rear garden, with seating area, which is attractively planted and safe for use by residents. Within the home, there is a choice of communal areas on the ground floor that are comfortably furnished and pleasantly decorated, including a recently refurnished quiet lounge and a large diner with adjoining seating area. Each of the residents’ private rooms, visited by the Inspector, appeared to be furnished and decorated to a good standard.
Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 15 The home appeared to be very clean and there were no unpleasant odours; the home employs two domestics. A fire risk assessment for the building has been carried out and is routinely reviewed by the acting manager, when fire alarms and emergency lighting are checked also. The recommendations from the Fire Officers last visit, during the last twelve months, have been carried out. However, the Inspector recommends that auto-release fire safety door closers be fitted in areas, where doors are to be kept open for residents’ comfort and ready access. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good; the staff are trained in safe working practices, appeared to be committed to their work and to have a clear understanding of the residents’ support needs, evident from the positive relationships, which have been formed between staff and residents, observed during the inspection. This judgement has been made using available evidence including visits to the home. EVIDENCE: The duty rotas show satisfactory staffing arrangements are in place in respect of care staff; the acting manager, or deputy is rostered to be present, seven days a week. There is one waking and one sleep-in night carer, checks are carried out and recorded at intervals through the night. At the time of this inspection there were five carers and the acting manager, who had signed up to undertake NVQ training; none of the staff currently employed have achieved the NVQ award in Care. However, a training plan for staff included each of the recommended safe working practice topics e.g. manual handling, medication training, basic food hygiene, first aid, fire safety and elder abuse. The acting manager has introduced a well-constructed induction training for new staff. An examination of staff files showed that individual training and supervision records are kept and that satisfactory recruitment procedures were being followed, although it was noted that Police checks i.e. CRB and POVA had not been completed for all staff, prior to their appointment.
Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 17 Staff spoken with confirmed that they received supervision, felt well supported and that staff meetings were held; the acting manager was able to provide the notes that were recorded for these. Comments from staff reflected their enjoyment in their work and good team morale. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38 Quality in this outcome area is good; the acting manager has maintained and developed an open, positive and inclusive atmosphere within the home; she is suitably experienced and presents as a competent manager, though is not yet qualified in this area and therefore does not yet meet the required Standard. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The acting manager has been in post for approximately eighteen months and an application for her registration as manager is in process with the Commission. She has extensive relevant experience and will be required to complete the Registered Managers Award, within a given timescale, as a condition of registration. Good progress has been made in meeting the National Minimum Standards at the home, since their introduction in 2002. Each of the residents spoken with
Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 19 commented very favourably about the quality of service provided. The acting manager has introduced quality assurance measures that provide helpful feedback i.e. from satisfaction questionnaires, completed by residents, relatives and visitors to the home. The acting manager said that the responses had been helpful; the Inspector pointed out that by providing some feedback to residents e.g. during a residents’ meeting, this would encourage their further participation. The home has yet to produce an annual development plan, as an additional quality assurance measure. The atmosphere within the home is very relaxed, friendly and informal, which appeared to suit the residents very well. During a tour of the premises the Inspector discussed with the handyman the fitting of window restrictors that had recently been purchased by the owner for the safety of residents. The training of staff in fire safety practices was discussed with the acting manager. Records showed that three staff had received first aid training. Record keeping in the home is of a satisfactory standard. The Inspector reminded the acting manager of the requirement for the Commission to be notified of any events in the home that affect the health, safety, or well-being of residents. The acting manager maintains suitable records of individual pocket monies with receipts, where small personal items are purchased on behalf of residents. The home has adequate insurance cover, and a current certificate of insurance was on display in the home. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 20 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X 3 2 Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. 01 Standard OP28 Regulation 18(1) Requirement That a ratio of 50 of care staff receive the required training i.e. NVQ at level 2, or 3 in Care. (Timescales from previous inspections not yet reached) That all the required documents for newly recruited and existing staff are obtained, including CRB/POVA checks. That the acting manager applies for registration and NVQ qualification at level 4 in Care, together with the Registered Managers Award. Timescale for action 31/12/07 02 OP29 19(1)(b) 31/12/06 03 OP31 9(2)(b)(i) 31/12/07 04 OP33 24(1)(a) That an annual development 31/12/06 plan for the home is produced that is based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for residents. That all staff working at the home attend a fire safety training lecture, annually; such training to be provided by a professionally qualified person. 31/12/06 05 OP38 23(4)(d) Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 01 Refer to Standard OP19 Good Practice Recommendations That automatic fire safety closers are fitted, where doors are retained open for the residents’ ease of access and comfort. Abbey House DS0000048567.V312849.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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