Inspection on 13/07/06 for Abbey House Nursing Home

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Abbey House Nursing Home 03/10/07

Abbey House Nursing Home 05/12/05

Abbey House Nursing Home 29/04/05

Abbey House Nursing Home 29/11/04

Abbey House Nursing Home 20/04/04

Abbey House Nursing Home 16/06/03

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Abbey House Nursing Home 2 Abbey Hill Netley Abbey Southampton Hampshire SO31 5FB Lead Inspector Tim Inkson Unannounced Inspection 13th July 2006 09:00 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 Nursing Home DS0000011411.V297052.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 Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbey House Nursing Home Address 2 Abbey Hill Netley Abbey Southampton Hampshire SO31 5FB 02380 454044 02380 456989 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) Millennium Care Homes Limited Mrs Susan Ann Wilson Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (8), Physical disability of places over 65 years of age (43), Terminally ill (8), Terminally ill over 65 years of age (43) Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the categories PD and TI must be at least 50 years of age 5th December 2005 Date of last inspection Brief Description of the Service: Abbey House is located on the edge of Netley village and approximately 3 miles from Southampton city centre. It is within easy reach of local amenities in the village including, churches, shops, pubs, restaurants and an attractive country park overlooking Southampton water. The home is set in well maintained gardens, close to the historic ruins of Netley Abbey. Originally a large Victorian house, the building has been converted and extended for use as a care home. Accommodation is provided on 3 floors and there are passenger lifts and stair lift that provide access to all areas of the home. Other facilities include three lounges, one of which is on the first floor a dining room and a conservatory, assisted baths, a laundry service and full board. The bedroom accommodation comprises twenty-nine single and seven shared rooms; twenty-one of the single rooms have en suite facilities. Potential residents are given a “brochure pack” and a copy of the home’s “Service Users Guide” that provide information about the services and facilities provided by the home. There is a notice on display in the home informing anyone who may be interested of the availability of the Commission for Social Care’s most recent report about the home. Copies of reports of past inspection visits made to the home are also readily available in the entrance hallway of the home. At the time of the fieldwork visit to the home on 13th June 2006, the home’s fees ranged from £515 to £695 per week. The fees did not include the cost of hairdressing, podiatry, toiletries, clothing or dry cleaning. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 13th July 2006, starting at 08:35 and finishing at 16:00 hours. The process included viewing the accommodation including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practices was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 41 residents and of these 9 were male and 32 were female and their ages ranged from 67 to 103 years. No resident was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. Other matters that influenced this report included a pre-inspection questionnaire completed by the manager and received before the site visit and comments cards received from relatives and healthcare professionals. Also information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 5th December 2005, such as statutory monthly reports made to the home on behalf of the registered provider/owner and notices received about incidents that had occurred. What the service does well: What has improved since the last inspection? Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 6 There were no matters of concern identified at the last inspection of the home on 5th December 2005. The home’s facilities and services should be enhanced by the construction of a new extension due to be completed during the summer of 2006. 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 Nursing Home DS0000011411.V297052.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 Nursing Home DS0000011411.V297052.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were procedures in place to ensure that the home identified the assistance and support that potential residents needed before they moved into the home. EVIDENCE: The home had written policies and procedures concerned with the admission of new residents to the home and these referred to the importance of ascertaining the help required by potential residents before they moved into the home. A sample of the records of 4 residents was examined including those concerned with identifying the help and care that people needed. There was evidence from these documents that the admissions to the home of the individuals concerned had all been planned. On this occasion as at the last two inspection visits made to the home on 5th December 2005 and 29th April 2005 discussion with residents and relatives and documentation indicated that that information about the needs of potential residents was obtained before individuals moved into the home. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 9 It was also evident from the records examined on previous visits to the home that potential residents were contacted before they moved into the home informing them that the home could meet their assessed needs. The pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. Abbey House Nursing Home DS0000011411.V297052.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 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. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure; the personal and healthcare needs of residents were met and medication was managed safely and effectively. Staff working practice ensured that residents’ privacy and dignity was promoted. EVIDENCE: On this occasion as at the last two inspection visits of the home on 5th December 2005 and 29th April 2005, a sample of the care plans of residents were examined (4). The documents were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed (see pages 9 and 10). Assessments included a range of potential risks to residents e.g. pressure sores; falls; nutrition; etc. Among the assessment tools the home was a new document “the Braden scale pressure ulcer risk assessment” that had been developed at a hospital in Putney. Where this indicated that an individual was at risk it was noted that the corresponding plan of care for the person concerned referred to the use a pressure relieving aid. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 11 The plans examined set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. There was evidence from documentation that wherever possible individuals and/or their representatives had been involved in developing the plans and agreed with the contents. Staff spoken to were able to describe the contents of the plans that were sampled. Comments from residents, relatives and health care professionals about the abilities of staff and the care and support that the home provided included: • “I feel safe when they lift me in the hoist and I am happy that they know what they are doing”(resident). • “They are looking after me alright - – they don’t moan or anything when they have to clean me up” (resident). • “The home is overall excellent and I am very pleased with the care provided” (relative). • “I am impressed with this place- it has good quality caring staff and I wish that others were as good” (General Practitioner). • “I have been GP for Abbey House for 6 years. I have no concerns. I am impressed with the staff and care” (General Practitioner). • “The residents I have seen all look well care for” (visiting specialist nurse). Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. pressure relieving aid; Zimmer frame; hoist; soft diet/pureed meal; etc. Records indicated that care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Records examined also indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. There was evidence that specialist support was provided to the home when required e.g. leg ulcer nurse. Individuals’ health was monitored routinely and regularly e.g. blood pressure and weight. A visiting specialist nurse commented about her perception of the home’s proactive approach to the promotion of residents’ healthcare needs. • “The staff attend training that I provide, referrals from the home are appropriate. They are willing to learn and they understand their roles – they keep and have information about the patients – they are happy to purchase a Doppler machine so that they can do assessments themselves and then only call on me for complex cases. I will do the training with the staff team and they will then be able to deliver more holistic care”. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 12 The home had written policies and procedures concerned with the management and administration of medication. These had been reviewed and amended to included details about changes to the disposal of unwanted and unused medication that had been implemented nationally for care homes where nursing is provided in 2005. A range of reference material about medication was readily available including the most recent copy of the British National Formulary (BNF). Medication was kept in a locked room and also in 2 locked and secured medicine trolleys, and where required in a medical refrigerator. Controlled drugs were stored securely and in an appropriate metal locked cabinet. Medicines were dispensed from their original containers and the only staff responsible for the management and administration of medication were registered nurses. Good practice noted during the fieldwork concerned with the management of medication included: • Recording the temperature of the refrigerator used for storing some medication • Dating of containers of certain medications when they were opened because of limited shelf lives i.e. eye-drops and thyroxin • Sample copies of the signatures of the Registered General Nurses that dispensed medication • Some sedative medication was treated as if it was Controlled Drug The home strongly promoted independence and the registered manager said that those residents assessed as being able and who wished to were encouraged to keep, and take their own medication. At the time of the fieldwork visit however no resident was managing his or her own medication. The home’s Service Users Guide included information about its philosophy of care including among other things the promotion of service privacy and dignity. Most residents were accommodated in singe rooms and they said they appreciated the privacy that these afforded, particularly some of those that had the benefit of en-suite WCs. Those spoken to also said staff usually knocked before entering their rooms and this practice was observed during the inspection visit. Residents, relatives and other visitors to the home described the staff as respectful and polite. Comments about these matters included the following: • “Staff are polite - they are quite polite really”. • “They give a little knock before they come into our rooms”. • “I have my favourites but they are all polite”. Care plans examined included reference among other things actions that would promote residents’ privacy and dignity e.g. • “Offer protection for clothing at mealtime” • “Toileting - explain all interventions with tact and reassurance” • “Prefers to remain in his room for meals – monitor that meals are eaten”. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. The home organised a range of social activities and promoted selfdetermination, enabling residents to exercise choice about all aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were well catered for with a balanced and varied selection of food available that met their tastes and choices. EVIDENCE: The home employed an activities organiser and there was a publicised programme of regular events in which residents could participate. A notice board in the hallway of the home was displaying information about the home’s impending summer fete and the activities programme for July 2006. Also on display was the home’s newsletter for the same month in which there was reference to an exhibition of work by residents and the involvement of them in a project with Southampton Arts Society. Residents spoken to said that they enjoyed the activities that were arranged and two of them were particularly interested in arts and crafts including making cards and that they had enjoyed taking part in a reminiscence project. Comments about activities included: - Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 14 • • “We have been doing a reminiscence project. We have singers come in – we had one yesterday. We have an exercise lady every 2 weeks – sometimes she does one on one” (a group of residents). “They have entertainment now and again and you have a laugh at the exercises don’t you?” (A resident with a group of her relatives) The home’s activities organiser explained her role and described some of the raining that she had undertaken and work that she did. • “I do 4 afternoons a week – I liaise with visiting entertainers. For resident that are bedfast I spend some time chatting to them, a lot of them like me reading to them, they do feel a bit isolated in their rooms. I went to do some training at the Reminiscence Centre at Blackheath and I am doing projects with 2 groups of residents. I have a certificate in Activity Training Assessment and I have attended training days with an organisation in the New Forest. We are working with Southampton Arts Society with a project called “paint a memory that makes you happy” and there are 7 or 8 residents involved in that some who have dementia. Residents spoken to confirmed that they could exercise choice in all aspects of life in the home. One individual said, “We can get up and go to bed when we want – we are the stop ups we go to bed about 11:00 or 11:30 – the others all go to bed before that. I get up early as I can’t lie in once I wake up”. Details of the leisure interests and individuals preferred lifestyle were recorded in their care plans (see also at page 13 above). During this fieldwork visit a number of visiting relatives were seen and some were spoken to. One commented about the “open” visiting arrangements and said, “. I have been in here at 09:00 at night and I can walk in at any time and feel welcome”. Residents spoken to said that they were able to maintain contact with their families and friends: • “My daughter and grandchildren come and see me. One comes every Tuesday and my son comes in after he has been sailing” • “My son comes to see me, our visitors can come at any time”. Residents spoken to on previous inspection visits to the home indicated that they were able to exercise choice and also maximise the control they had over their daily lives in the home. Although most residents handed over the responsibility of the management of their finances to relatives or representatives, one resident continued to control her own financial affairs. Residents were able to bring personal items into the home including furniture and several individuals had taken trouble to personalise their bedrooms. The home also gave residents the opportunity to bring their pets into the home with them and one resident had brought her pet cat when she moved into the home. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 15 It was noted that information about residents was kept securely in the manager’s office. The home had written policies and procedures about “the control of records” and “access to personal files”. The former referred to the home’s obligations under data protection legislation and the latter to the right of residents to see their own records. The home’s Service Users Guide included details of a number of organisations that could provide independent advice, information or advocacy services for residents and their relatives. Also in the hallway of the home there were a range of publications produced by a national voluntary organisation that contained advice about “independent advocacy services”, “abuse” and “free health care”. Residents were generally complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. The menus and records of food provided indicated that the food was nutritious, there was a wide range of meals provided and a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft diets; salt free; and diabetic. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The main meals on the day of the fieldwork visit were attractively presented and consisted of: Gammon with pineapple with carrots, potatoes and peas, Or, Vegetable Lasagne, Or, Salad. This was followed by either apple crumble or blackcurrant crumble. Residents could normally choose where to eat and a number preferred to eat in their rooms. However at the time of this visit there were some restrictions on choice because of building work being done to construct an extension to the premises that had resulted in the temporary and short term closure of one of the communal rooms. The main meal of the day was observed and staff were seen sensitively assisting individuals unable to feed themselves and the occasion was unhurried and relaxed. Comments about the food provided from residents and relatives included the following: • “The food is very good”. • “The food is not too bad – sometimes its OK – there is enough – we have breakfast, tea during the morning – lunch – tea mid afternoon and then supper and drink before we go to bed”. • “The food is alright – there is plenty – too much”. • “The food is good the menu is nice – its nice to have a choice and the cakes are all homemade, they are lovely. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 16 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 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure and residents’ were confident about raising concerns with the home’s management. Robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All residents and relatives spoken to were confident about raising any concerns with staff or the home’s manager. • “I had to complain to the office when Mum lost a new jumper – I am confident about complaining to the matron”. • “If I was unhappy I would complain to Sue she would try and put it right”. • “Twice since Mum has been here I have spoken to matron and she always takes it seriously”. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and the outcome. There had been no complaints made to the home since the last inspection on 5th December 2005. One complaint had been made to the Commission for Social Care Inspection (CSCI) about the home in the last 12 months (see below). The home had written procedures available with adult protection. Theses were intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm was prevented. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 17 The manager said that all staff in the home had or were in the process of completing a training course in adult protection/abuse. Staff confirmed that they received training and an examination of staff training records confirmed this. Staff spoken to were able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Where subsequent to an assessment it was considered necessary for a resident’s safety to use bed rails written permission/consent was obtained. The home’s manager had in the past been proactive about adult protection. On one occasion she had the appropriate procedures by contacting the relevant local authority, which had the statutory responsibility for co-ordinating adult protection investigations, when she became concerned that a resident living in the home might have been financially abused. Early in 2006 an allegation of abuse was made following the admission of a resident from the home into a local hospital. The subsequent investigation completely exonerated the home and the local authority responsible for conducting it stated: • “There is no evidence of concerns about the level and quality of nursing at Abbey House. There should be no concerns in relation to making placements there”. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. The home’s environment was safe and well maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: The exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. The home employed two maintenance personnel to undertake repairs and redecoration. An extension to the home was nearing completion that should enable the home to provided accommodation for another 5 residents. All the new rooms will have en-suite level access showers. The home will benefit from an extended communal lounge and a newly landscaped front garden. The home’s manager said that the home had contracted with the local primary care trust to provide intermediate care for 6 residents. The residents in receipt Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 19 of this service would be accommodated in the 5 new rooms and a refurbished existing room and the part of the premises used for intermediate care would be “self contained. The local fire and rescue service had not visited the home for more than 12 months but there was a detailed fire risk assessment in place and records and discussion with residents and staff indicated that fire safety was treated seriously by the home. • “They test the fire alarms on a Monday – they frighten the life out of you” (residents). • “We have fire drills and training 3 or 4 times a year. Matron is very hot on that” (member of staff). The local environmental health officer had visited the home on 5th April 2006, and had examined the homes food hygiene procedures and corresponding records and had not identified any matters of concern. There were comprehensive written infection control procedures in place and staff had attended training in the subject. The infection control procedures referred to among other things effective hand cleaning and the use of protective clothing. The latter was readily available and one member of care staff said: • “There is plenty of protective clothing, aprons and gloves and they are put in bedrooms and bathrooms so we can get them easily. I have done an infection control course”. The home was clean and odour free at the time of the fieldwork visit and comments from residents and visitors about the cleanliness of the premises included the following: • “They are always cleaning and the bed is always made”. • “I think it is clean they come round the room with a vacuum and duster and do everything”. There were sluice disinfectors available on both floors of the home. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents were met. The home had clear staff recruitment, training and development procedures that ensured that service users were protected and supported. EVIDENCE: The total number of staff employed to work in the home at the time of the fieldwork visit was 60, this included 8 registered nurses and 29 health care assistants and of the latter 11 had obtained a qualification equivalent to a National Vocational Qualification level 2 in care (i.e. 33 ). The registered manager said that another 6 heath care assistants were pursuing the qualification. Staff, residents and relatives said that the staffing levels in the home were sufficient and service users also expressed confidence in the abilities and competence of the staff to meet their needs (see also above at page 12). Comments from residents and relatives about the sufficiency and competence of staff included the following: • “I think there are enough staff – but sometimes we have to wait for a hoist if we need one” (resident). • “Overall its not bad – sometimes short at weekends when sometimes you have to wait – if everyone wants to go to the toilet at the same time you will have to wait” (group of relatives with a resident). • “They come quickly if I use the bell – they are pretty good” (resident). Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 21 “I think that there are enough staff” (staff member). “We have 7 carers and 2 nurses in the mornings and 6 carers and 2 nurses in the afternoon. We can cope with that, but I am not saying it’s easy, it is hard work (staff member). • “The staff are helpful – they are lovely, the foreign ladies are so kind” (relative). Three out of four comment cards received from relatives indicated that they were of the view that there were sufficient staff on duty at all times. The home’s registered manager said that at weekends and in the evenings there were no administrative staff on duty to answer the front door. If all the staff on duty during those times were helping residents with their personal and nursing care needs there would be a delay in responding to the front door bell which could be perceived as arising from a staff shortage. The care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 08:00 – 14:00 2 7 9 14:00 – 20:00 2 6 8 20:00 – 08:00 1 4 5 • • Registered nurses Health care assistants Total Apart from registered nurses and care assistants the home employed other staff and these comprised. Administrators Training co-ordinator Activities organiser Kitchen assistants Laundry assistant Cooks Hostess Cleaners Maintenance personnel Records were examined of 3 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 5th December 2005. All statutorily required information and checks had been obtained and conducted before they had started work in the home. All new health care assistants were provided with a copy of the General Social care Council’s code of practice. The home’s registered manager said that she had also obtained satisfactory Criminal Records Bureau certificates for the podiatrist and hairdresser that visited the home frequently and who both had unsupervised contact with residents. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 22 The home employed a part time training co-ordinator and all new staff received comprehensive induction with health care assistants completing a programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions. There was evidence from staff training records that were examined that staff also attending training in matters that were relevant to the care and support provided by the home e.g. palliative care; pressure care; infection control. All staff spoken to were enthusiastic about the opportunities to undertake training and enhance their skills and knowledge. Comments from staff about their training included: • “One of our nurses is a trainer. I am working towards NVQ level 2 – I am enjoying it – the programme package is hard work – there are 11 sections including POVA (protection of vulnerable adults); infection control; health and safety. We look at the values like privacy and dignity - when we do any training we complete a “post training form - – I had an appraisal about 6 months ago”. • “I started on January 9th – I am doing NVQ level 2 – I have come in today to do some work but it is my day off - My induction included working with a senior member of staff for about a month. I was given an induction folder that I have completed and I have done my induction and foundation training. I have watched a video on abuse and completed a workbook”. • “I have been here about 2 months. Before I came here I was 2 years at another nursing home. I am a nurse in Romania. I am doing my induction training at the moment but I did TOPSS induction training at the other home”. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 23 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s manager provided effective leadership There were systems and procedures in place for; monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The registered manager was a registered nurse and had been responsible for the day-to-day functioning of Abbey House for some 5 years. Prior to working at the home she had been the manager of another home proving nursing care that was owned by a large national corporate provider. Since the last inspection visit to the home on 5th December 2005 she had kept up to date with developments, maintaining and improving her knowledge and skills by attending training sessions in the following subjects: • Tissue viability Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 24 • • Pressure care Protection of vulnerable adults She was pursuing the “registered managers award” but had transferred from the academic institution where she was doing the course to another college because of a change of tutors. She was hoping to complete the qualification by Christmas 2006. As a result of discussion with the manager and also from observing her in conversation with staff, relatives and residents, she presented as; organised; highly motivated; enthusiastic; concerned; sensitive and empathetic. Comments from staff, residents and others about the registered manager were all positive and included the following: • “Sue is quite good really, if you have a problem she will come and see you and talk it over” (group of residents). • “No matter what Sue is doing her door is always open. She is friendly and open but tough. She is always ready with advice and help” (staff member). • “Sue is very approachable, she gets things going and is very supportive. When I worked for the NHS they said a good boss is fun, fair, flexible and shows no favouritism and she has got all that” (staff member). • “I am very impressed with the manager she always wants to help us and correct any mistakes” (staff member). • “Sue is on the ball” (visiting specialist nurse). The home had procedures and systems in place for monitoring the quality of the service that it provided that included audits of various aspects such as, the kitchen and bedrooms. The registered provider arranged monthly visits to the home and reports were produced of the outcomes of those and copies were provided to the Commission for Social Care Inspection (CSCI). Consumer satisfaction surveys were conducted and relatives were sent questionnaires seeking their views about aspects of the service that the home provided. Views about the quality of the home’s service and staff including those provided in comment cards sent to the CSCI included the following: • “Its quite good” (resident). • “I have been satisfied- we are all satisfied” (resident with a group of her relatives). • “The home is overall excellent and I am very pleased with the care provided” (relative). • “Generally speaking it is very good - The home send me questionnaires quire regularly about the food and accommodation all the sorts of things you are asking about” (relative). • “I am impressed with this place- it has good quality caring staff and I wish that others were as good” (healthcare professional). • “I think that the home is very good, clean and the staff are approachable. The residents I have seen look well cared for. I like coming here some I go to I don’t” (healthcare professional). Staff comments about working in the home included the following: Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 25 • • “I think it is brilliant, friendly – there is no stiffness between nurses and carers”. “It’s a very relaxed and friendly place”. The home had a range of written policies and procedures and on previous inspection visits top the home all staff spoken to said that they were readily available, helpful and influenced the care practices in the home. There was evidence that these policies and procedures were updated and amended as necessary (see at page 13 above, concerning medication). The registered persons were well aware of their legal obligations and were committed to ensuring that standards were maintained. Consequently there were no requirements or recommendations made a result of last two inspection visits made to the home on 29th April and 5th December 2005. The home looked after no money for or on behalf of any residents. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; boilers; fire safety equipment alarms, emergency lighting; portable electrical equipment; temperatures of fridges, freezers and cooked food etc. There were contracts in place for the disposal of clinical and household waste and pest control. Staff said that they attended regular and compulsory fire and other health and safety training and residents said that the home’s fire alarm system was checked every week. There was a fire risk assessment for the premises and regular risk assessments of the premises were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. The home had 2 staff trained as accredited manual handling trainers and there were hoists, and other equipment in the home to promote safe working practices. Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 26 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 N/A 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 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 27 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. Refer to Standard Good Practice Recommendations Abbey House Nursing Home DS0000011411.V297052.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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