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Inspection on 20/05/09 for Abbey Lodge Care Home

Also see our care home review for Abbey Lodge Care Home for more information

This inspection was carried out on 20th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Key inspection report CARE HOMES FOR OLDER PEOPLE Abbey Lodge Care Home 10 Leeds Road Selby North Yorkshire YO8 4HX Lead Inspector Jean Dobbin Key Unannounced Inspection 20th May 2009 09:10 DS0000044443.V375841.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbey Lodge Care Home Address 10 Leeds Road Selby North Yorkshire YO8 4HX 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) 01757 703339 01652 655888 rob.pursey@tesco.net North Lincolnshire Care Limited Miss Emma Louise Dodgson Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include up to 23 (OP) and up to 23 (DE(E)) up to a maximum of 23 Service Users. 4th December 2008 Date of last inspection Brief Description of the Service: Abbey Lodge provides personal care and accommodation for up to 23 older people, who may have dementia. The home is an adapted detached house in its own grounds near to the centre of Selby and close to all local amenities and transport systems. There is some car parking available on the site and the home has a safe garden for people to use. The home has a dining room, two lounges and a sitting area in the entrance hall. The accommodation consists of primarily single bedrooms, which are mostly on the ground floor. Some of these have en suite facilities. Two are double rooms, for people who choose to share. A small number of rooms are on the first floor and a stair lift is used for those people unable to manager the stairs independently. The weekly fees to live at Abbey Lodge are between £398 and £421. Additional charges are made for hairdressing, chiropody, and personal items like toiletries and newspapers. The Statement of Purpose, service user guide and report written by the Commission for Social Care Inspection, which was the predecessor of the Care Quality Commission, are displayed in the hall for people to read. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes • Information about the home kept by the Commission for Social Care Inspection. This includes the Annual Quality Assurance Assessment or AQAA, which the manager provides each year and which contains information about the home. Information from surveys, which were sent to people who live at Abbey Lodge, to staff and to other professional people who visit the home. 10 were sent to people at the home, and all were returned. 7 were sent to healthcare and social care professionals and 2 were completed and returned. 5 were sent to staff at the home and 1 was returned A visit to the home by one inspector, which lasted about 8 hours, and a shorter visit by a second inspector on the same day. The longer visit included talking to people who live there and their visitors. To a visiting healthcare professional and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Abbey Lodge. The second inspector undertook an assessment, where some people were observed for two hours to assess both their well-being and how the staff interact with them. What was seen is included in the main part of the report. • • • • Information about what was found during the inspection was given to the registered manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 6 What the service does well: People are assessed before they move to the home. This is so that the manager can check that an individual’s needs can be met, should they choose to move to the home. The home is warm, clean and comfortable, which makes it a nice place to live. All the surveys completed by people living there say that the home is ‘always’ fresh and clean. People say that they like the meals they receive at the home. their experience of living there. This adds to Visitors are welcomed any time. One visitor said that a member of the family visited every day and said ‘we’ve no complaints at all’. What has improved since the last inspection? The care records are now written in a way that recognises what people can still do for themselves. The care plan tells carers how much help they need to provide, to enable the person to maintain these life skills. The care records also emphasise what makes one person different to the next, so staff can work to maintain these differences. Staff are talking to people in a more positive manner. They are explaining what they are going to do, before they do it, and they are waiting for people to respond to their questions, wherever possible. This means people are being shown more respect. The staff now provide more varied activities and events at the home, to make people’s lives more interesting. There are more ornaments and other homely items in the communal areas, which add interest and talking points for the people living there. The change in the use of the communal rooms has meant that people have more choices as to where they spend their time and enables the outside space to be used more. More than half the care staff have now achieved, or are working towards, a National Vocational Qualification Level 2 in Care. This helps to provide staff with good up to date training, which meets recognised standards. It also helps staff to work in a safe, consistent way when providing people with care. The home is now consulting with people living there and to people who have an interest in how the home runs, so that they can say what matters to them and what changes they would like to see. This means people can now influence how the home runs. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 7 The manager is now informing the Commission promptly whenever something happens at the home, which adversely affects someone who is living there. Law requires this, so that these events can be monitored. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 8 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 Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. The pre admission assessment ensures that individual care needs can be met at the home and the prospective resident and their family receive information and help to enable them to choose whether Abbey Lodge is the right place for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Abbey Lodge has a brochure, which describes the home and its facilities and this is given to all people who express an interest in moving to the home. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 10 Since the last inspection six months ago the home has created a new preadmission assessment form, which looks at people’s needs in much more detail. This information helps the manager to write a plan of care for the person, which is very individualised and clearly identifies how one person is very different to the next. Only one person has moved to the home recently, however this was an emergency admission, so the manager was not able to visit the person first to carry out this assessment. At the last inspection though it was noted that this process did happen and the manager visited the individual before they moved to the home, whether they were in hospital, another care setting, or in their own home. This new person’s care plan contained a detailed assessment completed by the individual’s care manager. The dates confirmed that this had been faxed to the manager of the home in advance of the person’s arrival. The manager carried out her own assessment on the day the person moved there. This is important so that staff can be informed and read about the sort of help and support the new person needs. The manager should try to provide as much information to staff in advance of the person’s arrival so that care staff have some understanding of an individual’s needs from the word go. One carer spoken with was working on the day the person arrived at the home, but said they didn’t know about what sort of help they needed before they arrived. One person visited the home during the day with their relative to enquire about some respite care. They were keen for this to be organised however the manager discussed with her deputy that an assessment needed to be completed before they agreed that the person could stay there. Intermediate care is not provided at Abbey Lodge. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. People’s health and personal care needs are generally now being met, and in a more individualised way, however the written records underpinning this care are very new, so need some time to show they are being reviewed and amended appropriately. Medication processes in the home are still not good enough. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The way care staff interact with people has changed since the last inspection. One carer spoken with said that they now recognised the need to support people to do things for themselves, rather than ‘doing things for them’. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 12 Two care records were looked at in detail and another one more briefly. These describe the care and support people need to try and maintain a level of independence as far as possible. The manager has introduced completely new documentation, which is much easier to read. One of the three looked at though did not contain a photograph of the person, so an unfamiliar carer may not be confident that they were talking to the right person. These new records now emphasise what makes one person different to another and stresses the importance of providing people with choice as much as possible, in their day-to-day routines. These care plans now record exactly how much help people can do for themselves, and what extra support they can expect from staff. For example one stated that the individual can brush their own hair and can wash their face and front when bathing, if prompted, but cannot manage to clean their dentures. They also record whether people would prefer help from a male or female carer when bathing, whether they prefer to bathe in the morning or evening, and whether they would prefer a shower or bath. Whilst this is good practice, as discussed later in the report under ‘Staffing’, these preferences may be difficult to respect. There are care plans describing people’s communication needs and how these are to be met. One referred to the need for an individual to always wear their hearing aid and the setting that was required. Assessments were in place for the risk of harm to people from falling, developing pressure sores or becoming malnourished. Information was recorded about the help people needed when moving around the home. However all these written records have only recently been completed so it is not possible to assess how they will work, or how well they will be amended, as people’s needs change. The manager needs to have good systems in place to make sure the records remain an accurate account of people’s care needs. Daily records are still computerised so are stored separate to the care plans, to which the information refers. This makes it more difficult for staff to refer to easily or for authorised people to check that people’s needs are being appropriately met. There is evidence that the home generally refers appropriately for guidance with meeting healthcare needs though the way this is recorded makes it difficult to check this. Changes were made on the day of the visit to make it easier for the manager to check that advice has been sought, and then followed, properly. One healthcare professional spoken with said that the home was ‘on the up’. They said that they had ‘noticed a great difference and people are being looked after well. And staff seem happier too’. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 13 One person’s written assessment though said they were at ‘high risk’ of developing a pressure sore, but there was no record of referral to the community nurse for guidance. The nurse visited and assessed the individual and said that no special care was needed at this time. However the manager must seek guidance promptly when assessments identify high risk and she must have systems in place so that she is kept well informed of changes in people’s health care needs. Medication systems are still not good enough. The checks put in place by the home are not robust and shortfalls are still evident. Hand written prescriptions on the medication records are not signed, dated and countersigned. These systems are required to minimise the risk of the wrong information being written down. The numbers of tablets are not carried over from the old to the new medication record, so it is impossible to check whether people are receiving their drugs according to their prescription. One record sheet stated that the person did not receive any of their drugs on one day. The manager said they had been given them, but the carer hadn’t signed for them. This should have been identified when staff were carrying out checks. Other gaps were evident where carers had failed to sign the record sheet, so it was unclear whether people received their drugs. The controlled drug register had not been filled in when the most recent drug had been administered. This means that the home does not have an accurate record of controlled drugs stored there. And prescribed ointments and creams are still not being signed for, by the carer who administers this care. The record sheets must be an accurate record of which staff member gives the drug. The room where medication is stored still looks very uncared for. The floor was sticky and the medication records and audit sheets were scribbled on and generally not maintained in a responsible and professional manner. The assessment completed by the second inspector helped to demonstrate that people are now treated in a more respectful manner. Staff were observed assisting people in a kind and gentle manner. They helped one person to move, with the aid of the hoist, and they explained the manoeuvre as it was taking place and checked that the individual felt safe. People are being consulted more and carers are listening to what they have to say. Carers were observed knocking on doors before entering people’s private rooms and the written records emphasised the need to promote people’s dignity and privacy whenever care was being provided. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. People lead more interesting lives and are better supported by staff, to make choices and decisions about how they lead their lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People look well cared for. Their clothes were clean, and some of the ladies wore jewellery and nail varnish. The home felt calm and welcoming and there was a lot of gentle banter evident between staff and the people living there. People can move around the home as they choose and the way the communal areas are now arranged means that people have more choice of where to sit. There is a quiet lounge for people who do not want the television or music. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 15 Since the last inspection the home has gathered more items that may interest the people living there. There are rummage boxes of beads and handbags and more magazines. People can help with housework if they choose, because a dustpan and brush and dusters are available for them to use, and doll therapy is also provided. The home has a flexible approach where people can get up when they choose and breakfast is available, as people need it, for much of the morning. Promoting more individualised care means that carers know more about people’s pasts and what interests them. This makes it easier to have conversations that mean something to them. People now lead more interesting lives. Care staff are more available for people in the lounges and so can respond to people’s requests more quickly. On the day of the visit some people played skittles or threw a large ball or beanbag. Two people played Connect 4 with the help of a carer. There was a lot of laughter and some people were chatting to each other. Magazines were available to read and one carer spent time looking through one with an individual. Care staff were observed crouching down and talking with individuals. They listened to what people had to say and there was a lot of smiles and other positive non-verbal communication. This helps to make people feel valued. A second inspector observed the interactions, which took place over a twohour period. This included the lunchtime meal. This was to see whether people appeared contented and whether the interactions that took place between them and staff members were positive and meaningful. This assessment showed that people were listened to, that staff recognised and responded when they were asked and that people were given choices and those decisions were respected. For example one person wanted to sit at a different chair for lunch and the carers helped them to change places. A carer noticed that an individual had food on their face and offered them a hanky so that they could wipe their face themselves. And when a carer promised they would come back after completing a task, they duly did so. This assessment concluded that people are indeed supported in maintaining some control of their lives and that care staff respect and value what people have to say. Organised activities take place twice a day for short spells as the manager says this suits people best. An outside ‘entertainer’ visits weekly and one visitor said their relative had visited when one of these sessions was taking place, and how people had seemed to enjoy it. The hairdresser visits weekly. A religious service was advertised for ten days later. Posters for these events were in a large print to help people read about Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 16 things for themselves. Visitors are welcomed any time. This was confirmed, when speaking with two visitors. The dinner of liver and onions with potatoes and peas, with ginger sponge and custard was well received. One person spoken with said the meals at the home were very good. The second inspector also observed that people were enjoying their meal and those needing extra assistance were given that help in a respectful, unhurried manner. There is a new three-week cycle of menus and a choice is offered at each meal. People choose their lunchtime meal on the previous day and their teatime meal earlier on the same day. Cooked breakfasts are provided on request and also for those people who are known to like this meal. Whilst drinks are available through the day the cold drink at lunchtime was only provided half way through the meal. The manager says drinks are usually available from the start of the meal, but that didn’t happen on this occasion. The cooks have information about people’s likes and dislikes. There was some fresh fruit in the kitchen and home baking was prepared for later that day. The catering staff have been given more written information about how to meet the nutritional needs of people with dementia or diabetes. However they still did not seem very sure of how to prepare foods to provide extra calories for people. The manager needs to ensure that the cooks have a good understanding of how to fortify foods if necessary, so that people’s nutritional needs can be well met. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. Whilst people can be confident that formal complaints will be looked into properly more informal comments are not well managed. More robust systems of protecting people from abuse are needed to ensure people are kept safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The complaints process is explained to people and their families when they move to the home and is included in the written information given to people. A simpler version, for those people with impaired understanding, would be good practice as this may make it easier for those people to know what to do if they are unhappy about something. Whilst all the surveys state that people know how to make a complaint, four of the ten people surveyed said that they did not know who to speak with if they weren’t happy. Staff need to be alert to changes in people’s behaviours that may signify that something is wrong. And the manager needs to continue to remind people of the importance of telling someone if something is bothering them, so that the home has the opportunity to put things right. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 18 Each person living there has a new care plan describing their communication needs and what different behaviours and gestures may mean. This is good practice and helps staff to recognise and understand individual’s responses. There has been one written complaint about the home in the last six months and this was made to the local authority. It alleged poor care practices and was made shortly after the last inspection. The manager has attended a number of meetings with the local authority to look into these allegations and has made changes to the way the home runs, to address some of the concerns. The care records looked at though, showed that one visitor had complained verbally, when they visited one afternoon, about their relative’s appearance. There was no written evidence that this had been looked into, nor any evidence that the visitor had been spoken with at a later date, to tell them what changes had been made to prevent a similar incident happening. All complaints, whether written or verbal, need to be recorded and evidence provided, to show how these have been dealt with properly. It is good practice to write down small ‘niggles’ too as this can help to identify similar ‘issues’ over a period of time, which may need looking into. The home has a complaints/suggestions box however the manager says this is rarely used. Staff are given a booklet on safeguarding adults when they start working at the home, and then annual updates are organised. These updates though have lapsed. The manager showed that ‘ensuring all staff attend refresher training’ is on the home’s action plan following the last inspection. No dates are arranged as yet though. There have been two safeguarding referrals made in the last six months, which the manager reported promptly. One of these related to the complaint as mentioned earlier. One care worker spoken with said that they knew they must report any incident, which may be abusive, straight away to the manager. However when asked about an imaginary situation where a person living there complained to them about the behaviour of a second care worker, they said they would ask the second person if the allegation was correct, rather than reporting the conversation immediately to the manager. All staff at the home must attend safeguarding refresher training so that they are quite clear about what they should do should they witness or suspect an abusive incident. This will help to protect people from harm. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 19 The recruitment checks, carried out before a new person starts working at the home are not robust. (See Staffing outcome group). This means the manager is not doing all she should be doing to keep people safe. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. People live in a comfortable, adapted home, which now makes better use of the communal rooms, for the benefit of the people living there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is an old detached house, which has been adapted for its current use as a care home. There is ramped access and a safe garden, including a patio area, at the back of the home. The home was noted to be warm, clean and comfortable, with no unpleasant smells. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 21 Since the last inspection the manager has changed the use of the three communal areas. The second lounge, which was rarely used, is now used as a dining room. This means this room is now in daily use and also the patio area, which leads off the dining room. The remaining two rooms are sitting areas. The smaller room is used as a quiet area, which means people now have somewhere else to go if they don’t want the television or music. There are also now more items like ornaments and magazines in these rooms, which makes the rooms more homely and provides interest and topics of conversation. Most of the private rooms are on the ground floor and all except two are for single occupancy. Just a few rooms are upstairs and there is a stair lift for those people who need that help. Some of the rooms have private facilities. Two private rooms looked at had been personalised with items that were important to the person, to make the room feel more like home. Several of the bedrooms though have vinyl flooring, which, although easier to clean, do make the rooms feel rather institutional. One domestic was working on the day of the inspection. One person commented, when spoken with, that they thought the home was cleaner than it used to be. A handyman visits the home each week to carry out maintenance work as necessary. A recent visit from a health and safety inspector identified several shortfalls. Although the manager said these had all been addressed she was unable to locate a risk assessment, which that inspector had asked to be completed. All rooms needing to be kept locked were indeed found to be locked during the visit. Pictorial signs were used for the bathrooms, toilets and individual rooms, to help people to find their way around the home more independently. Care staff were observed wearing appropriate aids to protect both people living there and themselves from the risk of a spread of infection. The laundry room was not looked at on this visit. It was noted to be satisfactory at the last visit. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. People are helped by a staff team who are well supported and who now understand the need to promote choice and to recognise people’s differences. Current recruitment systems are not protecting people from potential harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four care staff were working on the day of the site visit. Two carers work the evening shift and two through the night. Care staff are no longer rostered to work very long hours. The manager works ‘on the floor’ when necessary, but generally has supernumerary hours. These numbers are for 16 people currently at the home. There are also catering and domestic staff working every day. These numbers were confirmed on the rota, except at the weekend, when the care staff numbers fall to three during the day. A new rota starts in June, where the numbers will stay the same each day of the week. The manager needs to monitor staffing levels and make sure they are adequate to meet the Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 23 needs of people living there. One staff member said in their survey that there was ‘sometimes’ enough staff to meet those needs. Although people have been asked whether they would rather have a bath on a morning or an evening the staffing levels may prevent those preferences from being met. Nearly all the people living at Abbey Lodge are ladies and since the last inspection everyone has been asked whether they would prefer to get help with personal care from a male or female carer. This is recorded in their care plans. The home though employs five male care staff so the manager must ensure that there are enough female staff working at any time to make sure people’s preferences can be respected. Survey responses to the question ‘do staff listen and act on what you say’ are more positive than six months ago, and nine out of ten people have responded ‘always’ to that question. This matches what was observed on the day, when staff were more available and the short assessment showed that people seemed more contented and more alert. One visitor commented ‘the staff are lovely. The place has a ‘good feel’’. One person spoken with they felt very safe at the home. Another was observed being moved with the aid of a hoist and this manoeuvre was carried out in a sympathetic and reassuring manner. More than half the care staff have either achieved a National Vocational Qualification Level 2 in Care or are working towards the award. This helps to provide staff with good up to date training, which meets recognised standards. It also help staff to work in a safe, consistent way when providing people with care. Two staff recruitment files were looked at. It was observed that these two staff members only had a standard police check, rather than an enhanced one, which is required in order to comply with the law. Other files also showed that those staff members had only had a standard police check done too. These checks had been requested and countersigned by a senior manager who no longer works at Abbey Lodge. All care staff need to have an enhanced police check and the manager has told us that all staff will re-submit application forms for enhanced checks. Good recruitment processes are needed to protect people from harm and the manager needs to satisfy herself that these checks are robust. Staff attend training compulsory refresher training although records of these events are kept in individual staff files. This can make it difficult for the manager to check and arrange training to make sure it be provided in a timely way. It also makes it difficult for authorised people to check this is being done properly. A training plan for the year is in place and attendance records help the manager to check that all the staff have attended. These were not looked at. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 24 There have been many staff meetings in the last six months where changes in the way the home runs have been made and the behaviours and working patterns of the staff team have been looked at. One staff member commented. ‘Things have got better in the last six months. We try and get people to do more things for themselves’. The home employs a number of care staff whose accents may be difficult for some people to understand. The manager and staff need to be alert that people may become more frustrated and upset if they don’t understand what is being said to them. The rota must ensure that someone with good communication skills is always on duty and that staff ask for help from a colleague promptly if people have difficulty either understanding instructions, or making themselves understood. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 People using the service experience adequate quality outcomes in this area. People are being consulted more about how the home operates, though some record keeping to evidence good practice needs to improve. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is qualified and registered with the Care Quality Commission to manage a care home. She has completed further training to help her with her role. She has a very gentle manner however and extra training to help her Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 26 deal with difficult issues may enhance her management skills. She showed in discussion though that she has a good understanding of people’s needs and how they are to be met. People spoken with, who were able to respond, knew who she was and saw her regularly around the home. There have been a lot of changes in the home over the past few months. The manager has prioritised the care records and updating staff’s knowledge and attitudes so that people can benefit in their day-to-day lives. A new senior manager has been appointed by the parent company, to support the manager with these changes. People are being consulted more about how the home runs. Changes in the way the communal rooms are used were made following comments made by a healthcare professional, who was asked what they thought about the home. This change has improved outcomes for the people living there. Staff have also been consulted about the improvements they would like to see. And a quality circle process has been started, where a senior carer speaks with relatives and discusses the home and how it could be improved. These comments are written down so they can be audited. A residents and relatives survey form has also been written and the manager says that this is to be used in the coming weeks to obtain more views about the service. A newsletter is now published quarterly. It is brightly coloured, contains photographs of past events and is inviting for people to look at. People’s financial records were found to be robust at the last inspection so were not formally checked this time. Then however, it was noticed that people could only access their money when one of the two managers was available. This situation has not changed. People need to be able to have their money when they need it. The manager says they are looking to make changes to enable this to happen, but this hasn’t happened yet. Some of the records that the home has to keep, to evidence that it is running well need to be looked at in more detail. Robust audits need to be introduced and records kept, showing that the manager is monitoring processes at the home. Medication systems are still not good enough. Although medication checks have been introduced, these are not robust, so failures are still happening. Individualised assessments of risk to people, in the event of a fire, have not been completed. Some record keeping though has improved. The manager now reports promptly to the local authority, when an incident occurs, which may be abusive. Sharing information in this way helps to promote people’s safety. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 27 Hazardous products are stored appropriately and monitoring arrangements are in place to ensure the delivery of safe hot water and minimise the risk of Legionella. A few random safety certificates were checked and found to be in date. The gas safety certificate was not available to look at but was faxed to the commission in the days following the visit. People at the home still need a written assessment of risk, should there be a fire at the home, as their impaired understanding may affect their ability to help themselves, in the event of a fire. This was commented on at the last inspection but these risk assessments are mot yet available to look at. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 28 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 2 8 2 9 1 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 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X 3 2 Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement Guidance must be promptly sought from healthcare professionals when risk to health is identified. Records need to evidence that this happens. This will show that people’s health needs are being monitored and met properly. Medication must be administered as prescribed. An accurate record must be kept. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. The recording of controlled drugs must be accurate and consistent. This makes sure there is a complete record of these drugs. The manager must keep a record of all complaints made, to include details of any investigations and any action taken. This will show that complaints are being looked into properly. All staff employed at Abbey Lodge must have an enhanced, rather than a standard, Criminal DS0000044443.V375841.R01.S.doc Timescale for action 20/06/09 2. OP9 13 20/06/09 3. OP9 13 20/06/09 4. OP16 17 20/06/09 5. OP29 19 31/07/09 Abbey Lodge Care Home Version 5.2 Page 30 Records Bureau (CRB) check. This is to confirm that they are suitable to work in a care setting. People living at the home must have an individualised assessment of risk of harm in the event of a fire at the home. This would help to identify people’s different abilities and what help they need in such an emergency. 6. OP38 13 31/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should implement good written audit systems to make sure the new care plans accurately reflect the care that people need, as those needs change. This will help to ensure that help is given in a safe, consistent way. The manager should consider having the medication storage room redecorated as part of a planned maintenance programme. This may encourage staff to have a more responsible approach to medicine management. The manager should keep the staffing levels and the proportion of male and female care staff working on each shift, under review to make sure people’s needs and preferences can be met. The cook should have training about the specialist dietary needs of people with dementia. This would help to make sure people receive appropriate food for their needs. The manager could consider whether she would benefit from more training in managing difficult situations, as this would provide her with more confidence and authority. There should be some consideration given to having a system at the home where people can access some of DS0000044443.V375841.R01.S.doc Version 5.2 Page 31 2. OP19 3. OP27 4. 5. 6. OP30 OP31 OP35 Abbey Lodge Care Home 7. OP37 their own money, whenever they want it. This will provide people with more choice and control of their finances. The records which the manager has to keep to show that the home is running well could be reviewed and then kept in a way that makes it easier for both her and authorised people to confirm that robust systems are in place. Abbey Lodge Care Home DS0000044443.V375841.R01.S.doc Version 5.2 Page 32 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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