Inspection on 31/05/05 for Abbey House

This inspection was carried out on 31st May 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbey House 26/09/08

Abbey House 26/09/06

Abbey House 28/11/05

Abbey House 16/11/04

Abbey House 08/06/04

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

CARE HOMES FOR OLDER PEOPLE Abbey House 20-22 Albert Road Bexhill-on-Sea East Sussex TN40 1DG Lead Inspector Mike Flint Unannounced 31 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Abbey House Address 20-22 Albert Road Bexhill-on-Sea East Sussex TN40 1DG 01424 222534 None None Angel Health Care Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant post Care Home 23 Category(ies) of Old Age (OP), 23. registration, with number of places Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users should be aged 65 (sixty five) years or over on admission. 2. The maximum number of service users to be accommodated is 23 (twenty three). 3. Only older people who have been assessed as requiring residential care are to be accommodated. Date of last inspection 16 November 2004 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 H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out during a day in May 2005, when there were twenty-two (22) residents. The acting manager assisted the Inspector. Five of the residents were spoken with, three of these in the privacy of their own rooms. The cook, the cleaner and three of the duty staff were also spoken with individually about aspects of the home’s performance. What the service does well: What has improved since the last inspection? What they could do better: There has been a lapse in NVQ training for staff training and there are no current candidates. However, the distance learning in core subjects continues. The residents’ care planning documentation requires up-dating, a matter long outstanding, and the home’s pre-admission assessment document is required to be completed for all new residents. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 6 Residents commented on the lack of organised activities at the home over recent months. This clearly has an adverse effect on the quality of life in the home, particularly for those residents who are not able to go out independently. Several matters concerning the premises and its facilities remain outstanding from previous inspections. These include the provision of a usable second residents’ bathroom, the fixing of window restrictors, wherever there may be a risk to residents’ safety, and improvements to the level of artificial lighting in the dining room. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5, 6 Although staff have a good understanding of the residents’ support needs, there is no satisfactory system in place to ensure that the home is sufficiently well informed of individual needs, prior to admission. EVIDENCE: Social Services/ Healthcare assessments are available for those residents, who are funded. Although the home its own process of assessment in place, this has not been satisfactorily completed for all new residents, prior to their admission. This is required to ensure that residents are appropriately placed at the home and as a basis for initial care planning. Prospective residents, with their relatives, are encouraged to visit the home prior to admission. Trial periods are offered and these may vary though it is usually for one month. The acting manager and staff, individually and collectively have the skills and experience to deliver the care services that the home provides and the services offered appear to be based on current good practice. The home does not offer intermediate, or convalescent care services, and does not provide the facilities for that purpose. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Apart from the daily up-dates at handover, there is no clear or consistent care planning system in place adequately to provide staff with the information they need in satisfactorily meeting residents’ needs. Regular care plan reviews that include the resident are required in order to ensure that objectives and expectations are understood by all parties concerned. EVIDENCE: The home has produced care plans for residents, which include daily notes. However, the plans detailing individual needs and how these are to be met have not been regularly up-dated; it has previously been recommended that the present format for care plans be revised to make them more accessible. Following a previous recommendation, inventories to record residents’ (valuable) belongings, upon their admission, have been introduced. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 10 The acting manager confirmed that the home receives good support from the Community Health Care services, including District Nurses and GP surgeries. Residents are encouraged and supported in their self-care, though one resident commented that she would like to have more assistance; another thought there was not enough duty staff available to help with personal care. It was apparent that not all residents were aware, or accepting of the home’s ethos, in respect of encouraging independence. Some residents retain responsibility for their own medications, where this has been subject to assessment and advice from the GP. Staff with responsibility for administering medications have received appropriate training; the home’s procedures are satisfactory and the records regularly checked by the acting manager. Staff interactions with service users were observed to be attentive and friendly. Staff spoken with were familiar with the home’s policies on respecting service users’ right to privacy and dignity. A resident, who complained to the Inspector that staff no longer knocked before coming into her room, was found to have a significant hearing loss; the acting manager said that she would make sure that all staff were aware of this and the need to act accordingly. Private meetings and consultations may take place in resident’s own rooms. The Inspector attended the duty handover meeting on the day of the inspection, which provided evidence that staff have a good understanding of the residents’ healthcare needs, though this did not include discussion of residents’ social needs. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The lack of varied and organised weekly activity within the home has an adverse effect on the quality of life of the residents, in particular for those who are unable to go out independently. EVIDENCE: Residents are encouraged to retain their individual interests and those, who are able, are free to come and go from the home as they wish; one resident, who required assistance said that a carer would sometimes be available as escort on walks to the sea front; another said that she enjoyed attending a local day centre on one day a week. However, each of the residents spoken with in private referred to a lack of in-house activities. The acting manager confirmed that activities currently being arranged included a weekly video afternoon and outside entertainers, who come to the home at various times throughout the year. Two of the residents said that they chose to spend more time in the privacy of their own rooms. Many of the residents have brought personal items into the home e.g. furniture, pictures and ornaments. Individual inventories are completed of any items of value, with a copy kept on file. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 12 External advocacy services are available if required e.g. through Age Concern. Relatives and friends may visit at any time of the day and relatives, who had spoken with the Inspector previously, said that they were always made to feel welcome. The acting manager has recently revised the 4-weekly menu plan, in consultation with the two main cooks, to ensure that a varied and nutritious diet was provided; a third cook is employed at the weekends. Residents remarked variously on the quality of the meals and the way they were presented; overall, the comments were favourable and reflected the value that residents placed on being able to enjoy their meals. The cooks keep a note of individual preferences, or special diets to be catered for e.g. diabetic, and a record is kept of individual meals being served. The daily menu was posted up in the dining room and residents, who wished, were offered alternatives. The dining room at Abbey House provides a congenial and pleasing setting for socialising, both at mealtimes and at any other times during the day. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these Standards were assessed during this inspection. EVIDENCE: Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 26 The home provides a pleasing environment that is accessible, safe maintained, meeting residents’ individual and collective needs in a comfortable, homely style. However, the assisted bathing facilities the required Standard and this has the potential for restricting the residents may wish to bathe. EVIDENCE: The organisation, Wilton Lodge Limited employs two handymen to carry out maintenance work for this home and the other three care homes in the group. The standard of fittings, fixtures and décor throughout Abbey House is good. The acting manager confirmed that there were items noted that require attention and that these were shortly due to be addressed. At the time of the inspection the fire bells were being tested and records showed that fire safety drills for staff are being carried out regularly. and well very do not meet times when Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 15 The shared communal areas meet the needs of the residents and include a large living room and separate dining room, which are decorated to a good standard and comfortably furnished. It has previously been recommended that the level of artificial lighting in the dining area be improved, following several requests from residents. This has yet to be carried out. There is safe access to a private garden at the rear of the building, which residents said they enjoyed using, whenever the weather allowed. A gardener is employed and the garden appeared to be well tended. The home has an assisted bathroom and a shower room, which staff said was little used by the residents. The second bathroom was unserviceable and the home’s bathing facilities therefore do not meet the required minimum Standard. The requirement that a second bathroom be made available for daily use has been outstanding since the Company took ownership of the home two years ago, and is liable to be subject to an Improvement Notice, unless prompt action is taken. The acting manager said that staff were well able to manage the bathing requirements of the residents as things were, but that the option of a second bathroom would be of benefit. Two competent cleaners keep the home clean, tidy and fresh throughout. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staff presented as committed and enthusiastic about their work, which was reflected in the quality of care provided. However, in the absence of any NVQ training for staff it will not be possible to meet the required Standards in care. EVIDENCE: The home employs care staff and ancillary workers in numbers, which meet the standard in a care home of this size and category. There are three duty carers throughout the waking day with two night duty staff. There are currently no staff employed who are qualified to NVQ at level 2 in Care, or who were working towards this qualification at the time of the inspection. The registered person is required to promote this training and ensure that a sufficient proportion of staff achieve the specified qualification. On-going training for staff in core skills development, via distance learning, and on-the-job training continues to be provided. Details of all those employed at the home were available in the staff files. A sample of staff applications was inspected and was found to be satisfactory. Staff are issued with job descriptions and contracts of employment. The acting manager said that there was one part time staff vacancy only and that staff morale was good. The home provides an induction, which is home-specific; this ensures that all new staff are aware of their roles and responsibilities. Additional to this, the home has introduced induction and foundation training that meets the TOPSS specification for persons entering and employed within the care profession. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 38 The recent move of the registered manager to another of the homes, owned by Wilton Lodge Limited, and the promotion of an unqualified, senior carer to the post of acting manager at Abbey House has delayed the progress being made towards meeting the required Standards. EVIDENCE: The acting manager is an experienced and competent senior carer, who has the potential to run this home and meet its aims and objectives. There is a manager’s job description. It is planned for her to commence the required management training later in the current year. She was able to confirm that there was support and advice available from the home’s previous manager and from the owner. She also said that she felt staff are supportive and encouraging of her, whilst she is familiarising herself in the new role. Both the staff and residents commented favourably about her management style. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 18 The home regularly reviews aspects of its performance through the owner’s official monthly monitoring visits, which includes a programme of self-review and consultations with staff, residents and relatives. A senior manager has been appointed by the Company, commencing in July 2005, to provide additional management support to each of the homes, owned by Wilton Lodge Limited. The Inspector is encouraged by this response, on the part of the owner and in recognition of a perceived need e.g. particularly in respect of the managers, newly appointed at the Company’s homes. The atmosphere within the Abbey House was orderly, relaxed and friendly. Duty staff spoken with during the inspection presented as committed in their work; they were clear about their roles and responsibilities and said they felt well supported on a day-to-day basis. At the time of the inspection, the extent to which formal supervision were taking place for staff was unclear. It is recommended that the acting manager undertakes suitable training for this purpose. It is also recommended that staff meetings be introduced; staff were able to recall one such meeting only, during the past year. The previous manager has produced an annual development plan, reflecting the aims for the current year. However, due to the change in management, the majority of the actions indicated have remained unmet. The home has introduced induction and foundation training arrangements for all staff. There has been training in food hygiene, moving and handling and fire safety. It is recommended that the acting manager attends health and safety training and that care staff receive training in first aid and infection control, to ensure safe working practices are followed within the home. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 1 x x x 2 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 3 3 x x 2 x 3 Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 03 Regulation 14(1)(a) Requirement That the homes pre-admission assessment documentation is satisfactorily completed for all persons referred for admission to the home before they are admitted as residents. That a satisfactory system of care planning is introduced that is regularly reviewed in consultation with the resident concerned, unless it is impractical to do so, and that individual needs and how these are to be met are clearly documented and maintaned up to date. That the registered person, or representative on their behalf, consults with residents about a programme of activities to be provided at the home and arranged for their enjoyment and well being. That a second assisted bathroom is made available for use by residents i.e. to provide a ratio of one assisted bath to eight residents. (Timescales from 3 previous inspections remain unmet) Timescale for action With Immediate effect 2. 07 15(1) and 15(2) 01.11.05. 3. 12 16(2)(n) 01.11.05. 4. 21 23(2)(j) Revised to 01.11.05. 5. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 21 6. 28 18(1) 7. 31 9(2)(b)(i) 8. 36 18(2) That a minimum ratio of 50 of care staff receive the required training i.e. NVQ at level 2, or 3 in Care. (Timescales from previous inspections un-met) That the acting manager actively engages in management training, appropriate to her responsibilities, in particular supervision skills, health and safety training and NVQ at level 4 in Management with RMA That, additional to on-the-job supervision, staff receive formal supervision on a regular basis, covering all aspects of practice, philosophy of care in the home and career development needs, and that staff meetigs are introduced. End 2005 2005 ongoing 01.11.05. 9. 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. Refer to Standard 19 38 25 Good Practice Recommendations That, following risk assessments, window restrictors are fitted, wherever low window sills in residents private rooms may pose a significant risk to personal safety. That all staff receive training in safe working practices, including first aid and infection control. That lighting suitable to residents (expressed) needs is provided in the communal dining room. Abbey House H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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 © 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 H59-H10 S21450 Abbey House V220621 310505 Stage 4.doc Version 1.20 Page 23 - 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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