Inspection on 25/02/08 for Abbey Lodge Care Home

This inspection was carried out on 25th February 2008.

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

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

Other inspections for this house

Abbey Lodge Care Home 20/05/09

Abbey Lodge Care Home 04/12/08

Abbey Lodge Care Home 13/06/06

Abbey Lodge Care Home 19/10/05

Abbey Lodge Care Home 10/08/05

Abbey Lodge Care Home 25/01/05

Abbey Lodge Care Home 08/06/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Abbey Lodge Care Home 10 Leeds Road Selby North Yorkshire YO8 4HX Lead Inspector Kate Shackleton Key Unannounced Inspection 25th February 2008 09:45 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 Lodge Care Home DS0000044443.V360202.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 Lodge Care Home DS0000044443.V360202.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.V360202.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. 13th June 2006 Date of last inspection Brief Description of the Service: Abbey Lodge provides personal care and accommodation for up to 23 older people, a number of who have dementia care needs. The home is situated in its own grounds near to the centre of Selby and close to all local amenities. On the 25/02/08 the charges per week were £398. The most recent Commission for Social Care Inspection Report is held in the managers available for anyone to read. Abbey Lodge Care Home DS0000044443.V360202.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. The accumulated evidence used in this report has included: • A review of the information held on the homes file since its last inspection. • Information submitted by the registered provider in the Annual Quality Assurance Assessment document. This is information that the care service has to provide to the Commission for Social Care Inspection when we ask for it. • Feedback from surveys received from six residents, fourteen relatives, one staff and two GP’s. • One inspector visited the home. The visit was unannounced and lasted for about eight hours. It included a tour of the premises. Talking to residents and staff. Talking with the Area and Assistant Managers. Examining some residents and staff files, sampling a small number of health and safety records and observing staff working with residents. What the service does well: Residents and relatives like the staff. Comments received in surveys included “Staff are kind and considerate and are aware of her needs and issues” and “Thank the carers for all the help they have given me” The environment is comfortable and has a friendly feel to it. Relatives commented: “The home provides a safe secure environment for my mother” and “A happy warm homely house. Good rapport for residents, staff and visitors. Very welcoming and friendly” Staff and service users enjoy each other’s company. Staff put a lot of effort into arranging activities to keep service users stimulated and occupied. The owners of the home get the views of service users and relatives about the service provided so as to make any changes that improves people’s quality of life. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 6 The recruitment of staff is robust enough to ensure that only suitable people are employed. This minimises the risk of harm to residents. The staff are provided with comprehensive training to improve their knowledge and skills. This means that residents receive a service from staff that should be aware of current best practice. What has improved since the last inspection? What they could do better: When planning individual care for residents more attention must be paid to peoples right to enjoy fulfilling and meaningful lives. The manager must use every opportunity to empower residents and make sure that the staff team adheres to the aims and objectives of the service. Staff must pay more attention to supporting residents to exercise positive choices, maintain independent living skills, be spoken about in a dignified manner and have their privacy respected. This enables residents to maximise their full potential. Residents’ individual comforts must be better catered for so that they can experience a good quality of life all of the time. Medications must be administered in a manner that ensures residents receive their medicines as prescribed. This is to make sure that their medical treatment is treated correctly. Accurate records must be maintained. In cases where residents’ money is held by the service for safekeeping an accurate written record of all residents financial transaction must be kept. Receipts where possible must be retained. This provides a proper audit trail in the event of any financial irregularities. Robust procedures minimise the risk of residents being subject to financial abuse. Senior management needs to support the homes management to bring about these improvements and ensure that they are continued into the future. The manager needs to ensure staff understand attention to details and the correct terms to use when addressing people. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbey Lodge Care Home DS0000044443.V360202.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.V360202.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Proper assessments are completed prior to admission. There is the potential to adversely affect residents’ wellbeing by inappropriate admissions to the home. EVIDENCE: The manager visits prospective residents at home or in hospital and undertakes a comprehensive assessment of their care needs. Relatives are always involved where possible to find out more information that the resident may not be able to provide. Admission documents provided good information and included a copy of the care management assessment. Three residents’ pre admission assessments were examined. The local authority had referred one person for one-week short stay. The main needs of this person were related to mental health care. Abbey Lodge is not registered Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 10 to deliver this type of care service. The general risk assessment completed by the manager states that the resident must be supervised at all times. No additional staff was in place to achieve this level of service. Staff have not received training in the specific mental health care needs of this resident. Within a few days the resident had to be admitted to a psychiatric hospital. The homes Statement of Purpose details the type of service Abbey Lodge provides as older people requiring care as a result of ageing and people who have dementia care needs. The remaining two assessments were comprehensive and gave a clear picture of each persons needs. Abbey Lodge Care Home DS0000044443.V360202.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 ,9, and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some people receive the care that they need whilst others may not. EVIDENCE: Three residents’ files were examined. Two had care plans one did not. The resident without a plan is the person described previously in this report. This person had been admitted as an emergency on the 20th February for a sevenday stay. The area manager explained that the registered manager was intending to complete the plan on the 25th but circumstances beyond her control had prevented this happening. Anyone admitted, as an emergency must have a plan developed without delay in order for staff to deliver the care in line with the residents’ needs and wishes. Completing a care plan two days before the contracted discharge date is not good enough. The absence of a plan has the potential to impede the residents well being. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 12 The two completed plans detailed all of the residents needs and the support staff needed to provide to ensure the residents well being. For residents with dementia, other people who hold valuable information about them e.g. family members, General Practitioners, are consulted. This helps to ensure that the information in the plan is accurate. Case files contained regular reviews of the plan. This makes sure that service users changing needs are identified and acted upon. Staff acts as key workers for named residents. Staff was observed providing support in a kind and helpful manner and residents looked clean and well cared for. Staff training records show that training relating to residents rights to be treated with respect is provided. The daily report completed on each resident showed that any health care needs are reported and residents have access to the primary health care team. The services of other health care professionals e.g. chiropodist, dentist and optician can be made available. Surveys were received from two General Practitioners (GP’s). One confirmed that residents’ health care needs are met. Surveys received from residents and relatives included the following comments: “Thank the carers for all the help they have given me” “Staff are kind and considerate and are aware of her needs and issues” “I am happy with the care my mother receives. Staff are always happy to assist” “The well being, safety and best interests are always taken into consideration” “A happy warm homely house. Good rapport for residents, staff and visitors. Very welcoming and friendly” One visitor spoken to was satisfied with the service delivered to his relative. He stated his admiration for the staff commenting that they did a “good job” Since the home was last inspected concerns were raised by a pharmacist from the Local Primary Care Trust (PCT) about an anomaly involving controlled drugs dating back to 2005. A pharmacist from the Commission for Social Care inspection completed an unannounced inspection to look into the issues. The findings from this visit confirmed that there are poor systems for the accurate recording and storage of medicines. This puts people at risk of not receiving their medication safely and as prescribed. This may have an affect on their health and well-being. A report was sent to the provider detailing the failings and requirements were set for the manager of the service to improve the Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 13 situation within a timescale of the 07/03/08. Management have introduced measures as part of their Quality Assurance System (Cared4updates) to highlight any problems that need addressing. At this visit six Medication Administration Records were examined. Two records showed that cream had been prescribed but there was no record of it being applied. One record showed that some of the morning medication for one resident had not been signed as given. To be confident that residents are receiving their prescribed medication (creams and tablets) the administration record must be completed. It is important that accurate information is recorded on the charts so that medication is given as prescribed. This makes sure that the medical condition is treated correctly. The daily records for one resident showed that for a period of four days she had not been given her prescribed analgesic because the home had run out of tablets. The assistant manager put this down to problems with a local prescribing surgery not dispensing the prescriptions on time. A system must be in place to regularly check the quantity of medication so that a prescription can be ordered in plenty of time to prevent people being without their medicines. The controlled drugs register was properly completed with accurate recordings. One GP survey comments that there have been occasions when prescriptions have not been collected for ill patients, leading to deterioration in care. Protective pads were placed on chairs in public areas. A member of staff explained that these are to protect the furniture from soiling by residents who are incontinent. This is likely to be obvious to visitors to the home. Using these types of measures to manage incontinence demonstrates a lack of respect for the privacy and dignity of residents and disregards the need to provide a discreet service. Abbey Lodge Care Home DS0000044443.V360202.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some aspects of the care provided restricts residents’ ability to make real choices, though many residents enjoyed the activities provided. EVIDENCE: The Home has a wide and varied activities programme. This provides stimulation and social interaction for some residents. The initial assessment completed prior to admission takes account of peoples social interests, religious and cultural needs. Residents are encouraged to put their views forward for activities at residents meetings or with their key worker. Residents’ care plans detail individuals preferred social activities and wherever possible, they are encouraged to continue with a preferred hobby i.e. painting and knitting. Staff was observed involving residents in the life of the home e.g. helping to set tables. Discussions with the Activity Co-ordinator who visits twice weekly found that she keeps an individual activities book for each resident. She engages in one Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 15 to one activities with people as well as group activities. Trips out are arranged and there is a secure garden with a green house where residents can be involved e.g. growing tomatoes. Comments received from residents and relatives to improve the service provided included: More time spent outdoors in the summer months. They have a lovely garden which residents should be given the opportunity to enjoy. Perhaps more for residents to do would be an improvement. There is not much to do here would like to go out more More motivation from staff The residents need more activities. They need stimulation. The notice board highlights things going on in the local area. Information about local advocacy groups where independent advice can be sought is displayed. Abbey Lodge distributes a newsletter, which informs residents of any up and coming events, outings or activities. The residents also have access to the Selby Times and national newspapers. Routines are flexible. Residents were observed getting up and having their breakfast when they were ready. The service subscribes to enabling residents to maintain as much control and choice in their lives as they are safely able to. This was not evident at lunchtime. One observation made during this visit involved coming across two residents sitting in a “chilly” lounge. The radiator was not working properly. The television was on but facing in a direction away from the residents so they couldn’t watch it. A while later one resident was provided with a cup of hot tea in a cup that she was not able to manage safely. The area manager intervened to help to avert an accident and enable the resident to enjoy her drink. A staff member then brought in another cup of tea in a more appropriate cup. Both of these situations demonstrated a lack of consideration about the well being of residents. Abbey Lodge has an open policy for visiting. Family and friends are made welcome at all reasonable times and offered refreshments. There were a lot of visitors to the home during this visit. There are two sittings for meal times. A member of staff described this arrangement as one for “feeders” and one for “non feeders”. This way of speaking about residents is disrespectful. The main course is a set menu. An alternative is offered for people who do not like a particular dish, but this is not the same as been given a choice. A member of staff entered the dining room and said “It is spam fritters, beans Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 16 and waffles for lunch today is that ok? If anyone wants an alternative let me know”. She left the dining room without waiting for a response. An egg was heard being offered as an alternative to one resident. It may be beneficial if people are visually shown a choice of meals f to choose from. This allows for discussion to explain what it is. Other people may be able to make the choice earlier in the day. A healthy option should also be provided. The cook has not received training in providing a catering service to people with dementia. It was noted in the kitchen that the meals for the second sitting had been plated and covered with cling film. These are then micro waved as and when residents come into the dining room. The area manager was not aware of this practice and put a stop to it immediately. The inspector sat with residents throughout lunch. One resident was brought to the table in a wheelchair. The wheelchair didn’t have a seat cushion. This was pointed out to staff but nothing was done about it. This demonstrated a lack of consideration for the residents comfort whilst she had her lunch. She was having difficulty feeding herself with the cutlery provided and resorted to eating with her fingers. She eventually stopped eating. The inspector drew this to the attention of a staff member sitting alongside feeding someone else, and asked if a spoon could be provided. The resident then completed her meal. Lunch time for this resident lacked comfort and dignity and without the inspectors intervention she may also have been insufficiently nourished. Condiments and cold drinks are not on the tables for people to independently help themselves. The reason given was that one resident in particular would pour salt over his and others food. This is unlikely to happen if mealtime is properly supervised. It was explained that everyone’s life couldn’t be restricted because of the actions of one person. The whole mealtime experience provided no opportunity for residents to exercise real choice or be independent. Lunchtime was relaxed and unhurried allowing residents as much time as they needed to complete their meal. Appropriate support was provided for residents who needed to be fed. To promote choice and independence consideration should be given to actively enabling residents to serve themselves at the table. This will require proper assessment and supervision to ensure that everyone gets enough to eat. Best practice dictates that staff should actively encourage and provide imaginative and varied opportunities for people using the service to develop and maintain independent living skills where appropriate. Comments received from relatives included: More than one choice of meal should be available. Need to cater better for people who cannot chew. Everyone is given the same meal. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 17 She is clean and tidy and as far as I can see well fed with a good diet The food, drinks etc is excellent, good quality, plenty of it and varied nutritious diet Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints and concerns raised are properly followed up and appropriate action is taken to resolve the situation in the best interest of residents. Robust procedures and staff training protect service users from abuse. EVIDENCE: The Complaints procedure is displayed in the home and in each resident’s bedroom. The procedure displayed in bedrooms is in small print and not that easy for people with cognitive impairment to read. The record of complaints examined showed that any concerns raised are properly followed up in line with the procedure. Visitors spoken to said they would have no hesitation raising any concerns with management. Surveys received confirmed that people know how to make a complaint. There are policies and procedures in place to protect residents from abuse and guide staffs practice. There was evidence to show that proper procedures had been followed when allegations have been made. Staff receive training on abuse awareness and the one staff survey received confirmed that concerns are passed to the manager. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean comfortable home. EVIDENCE: The home is clean and fresh and has a friendly atmosphere. The home employs domestic staff to do the cleaning and laundry duties. Infection control measures were apparent. Antiseptic hand gels are provided for visitors entering and leaving the premises and staff carry their own supply. There have been no outbreaks of infection reported since the home was last inspected. At the last inspection requirements were made to improve the heating system and the arrangements for the safe delivery of hot water. Soon after this visit the Commission for Social Care Inspection received a complaint about residents’ bedroom being cold and problems with accessing warm water. An Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 20 unannounced inspection was done and this was found to be the case. Since this time a new heating system has been installed and radiators in residents’ bedrooms are fitted with valves so that people can control the temperature of their own room. The new system has addressed the hot water issues. Communal areas are comfortably furnished and decorated to a good standard. There has been significant redecoration and refurbishment since the home was last inspected. A maintenance/ refurbishment plan is done each year to maintain the premises in a safe and comfortable state. One lounge is used for the storage of hoists and wheelchairs. This is not conducive with a “homely” atmosphere, which aims to provide living space for residents to relax in. There are visual prompts around the home to aid identification of rooms. This enables residents to independently find their way around. Surveys received from residents and relatives confirm that the home is fresh and clean. Comments received included: The home provides a safe secure environment for my mother Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. To ensure the safety of residents staff are properly recruited and trained. EVIDENCE: Comments received from surveys suggest that there is enough well trained staff on duty. Agency staff are rarely used. Some example of responses are: “The staff show care in relation to the patients and skill in dealing with them e.g. lifting and handling.” “I have seen staff handle disabled people with skill” “The staff do a very good job and as far as experience I would not doubt them Abbey lodge care home and all their staff do a great job and we are most grateful” Staff was observed responding quickly to residents requests and spent time talking and listening to them. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 22 The recruitment process is robust and minimises the risk of employing unsuitable people. Three staff files examined showed that interviews take place and all pre employment checks are carried out. A proper induction training is in place for all new starters. All care staff have a training portfolio and relevant training is provided to ensure that residents receive care from a well-trained workforce whose practice is up to date. There is however situations described earlier in this report where some staff are not putting learning into practice. The one staff survey received confirmed that training is provided but there is not enough time for discussion. Staff are able to identify their training needs in regular supervision sessions with their manager. All care staff are encouraged to complete National Vocational Level 2 qualification in care (NVQ). Currently 38.5 of staff are working towards this. It is difficult for the service to meet the 50 required by the national minimum standards because of staff turnover. Abbey Lodge Care Home DS0000044443.V360202.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is generally managed well, though improvements in managing finances, and a greater understanding of the use of appropriate terms for people is needed. EVIDENCE: The manager is qualified and registered with the CSCI to manage a care home. The manager has completed the registered managers award. The manager was not available at this visit. Following this visit the inspector rang the home to ascertain where the CSCI inspection report is kept. During the conversation the manager explained that it had to be kept in the office and could not be displayed in the home because of the “wanderers.” This way of Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 24 describing residents is disrespectful and whilst no-one using the service heard this it is not an appropriate use of language. Staff are formally supervised every two months. This allows for discussions about any issues in relation to the workplace e.g. training, residents’ care and idea’s to improve service delivery. Comments received in surveys include: Quite happy with everything Abbey Lodge keep me well informed and assist in making decisions. My mother is well cared for in Abbey Lodge. Her needs are fully met. The area manager confirmed that she visits at least monthly and completes a report on her findings. She confirms that there is an annual development plan for the service, and audits of systems take place. This information was not accessible on the day of the inspection. Management use a professional quality assurance system to measure quality. It is a systematic approach to all the tasks and activities carried out by staff, which have a bearing on the quality of service provided at Abbey Lodge. Service users and relatives are surveyed as part of this process and residents’ meetings are held. This type of monitoring enables management to identify areas for improvement. Every month a policy is reviewed and if necessary updated. Management complete an annual quality audit review, this process is to ensure that all key aspects of running the home are examined. Management then analyse the results, which informs the development plan for the following year. Management seek to promote the health safety and welfare of residents through a range of procedures that guide staff. Regular maintenance and servicing of equipment is carried out. Comprehensive risk assessments of the premises are completed. The records kept in relation to the safe keeping of residents’ monies were poor. They were incomplete and individual receipts did not support the recordings for some financial transactions. Poor record keeping runs the risk of residents being exposed to financial abuse. It would be difficult to follow an audit trail if any financial irregularities arose. The manger is not following the company procedure on the recording of financial transactions. The area manager scrutinised the record sheets and determined that although inaccurately completed the final figures tallied. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Only people whose social/health care needs match with the registration category of the service can be admitted. Each resident must have a plan of care generated from a comprehensive needs assessment, which provides the basis for the care to be delivered. A system must be in place to make sure there is enough stock of medication to be given. Accurate handwritten entries must be made on the MAR charts. A system must be in place to check expiry dates of medicines and to add the date of opening when necessary. This makes sure that medication is being given as prescribed and is safe to administer. The management of incontinence must be discreet in order to maintain the dignity and privacy of residents. The manager must look for every opportunity to enable residents DS0000044443.V360202.R01.S.doc Timescale for action 25/03/08 2 OP7 15 25/03/08 3. OP9 13 (2) 07/03/08 4 OP10 12 25/03/08 5 OP14 12 25/03/08 Abbey Lodge Care Home Version 5.2 Page 27 6 OP35 17(2) to exercise independence and choice subject to a risk assessment and record this in the residents’ care plan. At each mealtime, residents must be offered a positive choice of food. Meal choices must be of equal value and shown to residents to enable them to make proper choices about what they eat. In cases where residents’ money is held by the service for safekeeping an accurate written record of all residents financial transaction must be kept. Receipts where possible must be retained. 25/03/08 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 Good Practice Recommendations DS0000044443.V360202.R01.S.doc Version 5.2 Page 28 Abbey Lodge Care Home 1. Standard OP9 2 3 OP19 OP30 A system should be in place to record medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. Wheel chairs and hoists should not be stored in lounge areas or any public area that residents have access to. This is not conducive with a “homely environment” Staff must not refer to residents in a disrespectful manner e.g. “feeders”, non feeders” and “wanderers”. The labelling of residents is poor practice and must not be tolerated. Staff must pay more attention to the individual comfort of residents. Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Abbey Lodge Care Home DS0000044443.V360202.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!