Inspection on 04/12/08 for Abbey Lodge Care Home

This inspection was carried out on 4th December 2008.

CSCI found this care home to be providing an Poor 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.

Other inspections for this house

Abbey Lodge Care Home 20/05/09

Abbey Lodge Care Home 25/02/08

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 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Abbey Lodge Care Home 10 Leeds Road Selby North Yorkshire YO8 4HX Lead Inspector Jean Dobbin Key Unannounced Inspection 4th December 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbey Lodge Care Home DS0000044443.V373094.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.V373094.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.V373094.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. 25th February 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 is kept in the office and is available for anyone to read. Abbey Lodge Care Home DS0000044443.V373094.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 0 star. This means the people who use this service experience poor quality outcomes This is what was used to write this report. • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Evidence from a Random Inspection carried out by a pharmacist inspector, who is employed by the Commission for Social Care Inspection. This was undertaken on 9 September 2008 and reference to the visit is made in the main body of the report. 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 of them were returned. 7 were sent to healthcare and social care professionals and 3 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 9 hours. This visit included talking to people who live there, 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. • • • • Information about what was found during the inspection was given to the registered manager and a director of the company at the end of the visit. We did this inspection with an ‘expert by experience’ who spoke to people who are using this service. An ‘expert by experience’ is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 6 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. What the service does well: What has improved since the last inspection? Some aspects of the way medicines are managed at the home have improved since the inspection carried out by the pharmacy inspector, and the medication records suggest that people are now receiving their drugs according to their prescription. The manager now makes sure that people only move to the home if their primary care needs are in the category for which the home is registered. This means that people are likely to be able to be cared for by staff that have received appropriate and relevant training. There is now more respect for people’s privacy and dignity as there are no longer protective pads in use on the lounge chairs. People are now given the choice of two meal options at lunch and tea. These plated meals are shown to people, when they sit down for their meal, to make it easier for them to decide. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 7 What they could do better: The records describing the care and support people need could be personcentred, stressing their abilities and strengths, and how staff can support them in maintaining some choice and control of their daily lives. This would help to respect people as individuals, with very different needs. When risk to a person is identified the home could confirm they have sought healthcare support. Care planning records could detail how a risk is to be managed. This would help to maintain people’s wellbeing. The way medicines are managed at the home could be improved so that drugs are stored and signed for properly and checks are carried out to make sure this always happens. This would help to make sure that the medication processes are being managed properly. The manager could make sure that the only people in the dining room are people having their meals or staff assisting people, so that people can have their meals without interruptions. The menus could be shown to a dietician to check that people who generally choose the ‘lighter’ option are receiving a balanced diet. All incidents at the home where one person is harmed as a result of someone else’s difficult behaviour could be reported to the local authority and the commission as required under local vulnerable adults protocols. This is so that people living at the home can be protected from harm properly. The manager could look at the way staff interact with people at the home, where staff become more engaged with people, so that staff involve people with what is happening with them and at the home. The home should continue to work towards achieving 50 of the care staff having a National Vocational Qualification Award Level 2 in Care. This would help to ensure people are supported in a safe, consistent way. The manager could continue to look at ways of gaining people’s views about the service and what is important to them. People could be told what the home is going to do as a result of these comments, as this would let people know that they have been listened to. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 8 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.V373094.R01.S.doc Version 5.2 Page 9 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.V373094.R01.S.doc Version 5.2 Page 10 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 and 6 People who use this service experience good quality outcomes in this area. People are assessed by a competent senior person to ensure their needs can be met if they choose to move to the home. 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. People’s care records looked at all contained a written assessment of needs, which had been carried out before the person decided to move there. This is completed by the manager, who visits the person, whether they are at home or in hospital, to talk with them about the kind of help and support they need on a day-to-day basis. This provides information to help the manager decide whether the staff at the home, have the skills and knowledge to support Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 11 people properly and whether the individual would ‘fit in’ if they choose to move there. The care records looked at also contained a written assessment by a care manager, which provides more information about their care needs. One person spoken with confirmed that their needs were assessed before they moved there. They explained that they were in hospital, and their family had visited the home on their behalf and advised them that the move would be the right move. A review meeting is held six weeks after an individual moves there. This is when a discussion is held as to whether the move has been successful and the person has settled and is satisfied with the support and care they receive. A service user guide describing the services and facilities provided by the home is displayed in each bedroom. The manager could consider providing ‘an easy read’ version of this document, so that people with impaired understanding could still read about the home and how it runs. Abbey Lodge does not provide intermediate care, but short respite stays are provided if a place is available at the time that it’s needed. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 12 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 this service experience poor quality outcomes in this area. People’s personal and healthcare needs are not being well met as the care provided does not promote and maintain people’s well being. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three care records were looked at in detail as part of this inspection, and several others were looked at briefly. These should detail the care and support that people need to stay as independent as possible, whilst living in a care setting. Each person’s care record is put together in the same way, so information can easily be found. Some of those looked at though did not include a photograph of the person. This is needed, as an unfamiliar carer would find it difficult to identify who is who, and some people living at the home may not be able to Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 13 confirm who they are. This is something the home says they are already addressing. The care plans provide a lot of information, but after looking at several people’s records it was evident that they were all very similar, in some cases with identical information written down. They generally did not identify how one person was different to another and were not written in a way that supported people to maintain life skills or choices in their day-to-day lives. For example ‘needs assistance with bathing’ does not describe whether a person can manage the task almost independently, can carry out parts with prompting, or is unable to participate at all. This detailed information needs to be written down so that staff provide the same level of support and the individual can maintain some control of their life. Some plans suggested little thought had been given to what was being written down. One person living there has significant hearing and sight impairment, however their care plan stated ‘ensure that X has access to the library, newspapers, TV and radio facilities’. This was a standard statement in the three care plans looked at. If care plans do not accurately describe the individual care and support people need, then staff are unable to check that they are providing the right care. People with dementia may be unable to explain what help they need and are likely to get different levels of care and potentially the wrong or insufficient care. This was discussed with the manager who explained new person centred plans were going to be introduced. Although the records show that the home has links with healthcare professionals, like the doctor, chiropodist, specialist mental health nurse and optician, the care plans showed some lack of how healthcare needs are to be met. Assessments were in place to show whether people were at risk of, for example, falling, becoming malnourished because of a health problem or poor appetite, or developing a pressure sore, however the record keeping did not clearly show how the home was managing those identified as ‘at risk’. Two people looked at had a high risk of developing a pressure sore. One had a special mattress on their bed and a chair cushion in their room, but did not use the special cushion in the lounge. The manager said the person didn’t like the cushion, but there was no written evidence that the home had sought further advice about alternative equipment. The other person did not have a special mattress on their bed. There was no written evidence to state what actions the home had taken about this. Two people have a chronic medical problem, which requires some support by the community nurse. There is no reference to the management of this condition in either care plan. It would be good practice for some written information about the condition to be included in their care plans so that staff have more understanding of the implications of this to the individuals involved. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 14 One person has a comment from a healthcare professional, made in the last month, requesting that the individual has their feet washed more regularly, to prevent possible complications secondary to their health problem. Despite this, the care plan relating to care of the feet has not been updated. Healthcare professionals returned two surveys. Whilst one person ticked all the boxes to suggest they were very satisfied with the care provision at the home, the other commented ‘this home consistently causes us concerns’. A social care professional commented in their survey ‘individuals with minimal needs are supported very well. When dementia related needs change this is not readily identified’. The accident records show that some people at the home are falling a lot. People have risk assessments in place, but the care plans for those at risk are not individualised. The manager needs to show that following every fall the person’s care plan is reviewed to check whether the home can do anything more to reduce the risk of another fall. The manager says that she has arranged for a falls specialist nurse, newly in post in the area, to visit and offer advice. Following concerns raised by a professional earlier this year, a pharmacist employed by the Commission for Social Care Inspection visited the home to carry out her own inspection. She identified several serious shortfalls and made a statutory requirement for these to be addressed by mid October. When looking at medication processes in the home it was clear that some of these shortfalls have not been sorted. The medication record sheets were generally completed properly and there is a record of authorised staff signatures, although it was being updated and wasn’t available to look at. Controlled drugs were stored and recorded properly. Refrigerated items were stored appropriately and items with a short shelf life when opened had been dated. The drugs fridge was badly iced up, and whilst temperatures of the fridge were generally recorded each day there were some gaps. The room temperature had not been recorded since early September, although the chart said it was to be done each day. The medications room is small, untidy and cluttered. The room has been painted, but the floor cannot be cleaned properly because of the clutter. The quantity of medication from one monthly cycle to the next is not recorded on the new record sheet. This makes it difficult to check, particularly if the drugs are prescribed ‘as required’, that medication is being given correctly. One person has their medicines given covertly, by hiding it in food or drink. Whilst there is a risk assessment and written authorisation from the person’s doctor, there is still no evidence to show that the pharmacist has been Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 15 consulted to check that the drugs will still work as they are meant to if they are given to the person in this way. Staff must dispense drugs in a proper way. We saw a member of staff put a tube of cream or a packet of tablets in their pocket whilst they went to the individual, this practice must be stopped. The present practice is unprofessional. Drugs should be stored and handled correctly at all times. If people are prescribed creams or ointments then the carer who applies that cream must be signing the record sheet, not the person carrying out the drug round. The record sheet should be an accurate record of which staff member gives the drug. One person had cream applied to their knee, whilst sat in the lounge, and had to lower her stockings for this to be done. This does not respect people’s dignity, and this should have been applied in her room, when she got up. Another person, declined to have cream applied, even when the carer offered to help them to their room. These creams need to be applied as part of their getting up routine. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 16 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 this service experience adequate quality outcomes in this area. Whilst people are provided with some organised activities and they can choose where to spend their time, there is little evidence of opportunities for people to occupy themselves. The mealtime experience could be improved so that meals are an enjoyable and social event. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: People looked generally well cared for. The ladies were tidily dressed; a number wore nail varnish and jewellery. Several said they were happy at the home, though some said there wasn’t much to do. All the people though moved around in one part of the home, with nobody apparently using the second lounge. The home has an activities organiser who works around 16 hours a week. A lot of her work is spent with individuals, talking about things that they are interested in, or looking at books or magazines together. There is also an activities programme, displayed in the hallway, which the staff help with. This Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 17 includes things like hoopla, bingo and exercise classes. On the day of the site visit one member of staff brought her dog in to the home, which people clearly enjoyed. Some balloons were also blown up and this caused some laughter as people batted them to each other. These events are important as they make people’s lives more interesting and varied. The home has a very relaxed and flexible approach. People can walk where they choose, and get up when they choose. Breakfast was provided during most of the morning and at a time that suited the individual. Drinks are offered to people mid morning and mid afternoon. The hairdresser visits the home regularly and a religious service is held at the home every month or so. A local member of the church visits in between times, if requested. Visitors can also call as they wish and are made welcome. One person spoken with confirmed this and also said they were looking forward to the hairdresser visiting. There was little positive and meaningful interaction from staff, except when they were providing care or support. Carers came into the lounge, where most people were sitting, and asked people generally if they were all right. There seemed to be few conversations, where carers crouched down and talked with people about a topic, which meant something to the individual. This type of activity is very important as it shows that people’s views and thoughts matter. The home needs to recognise when people can keep some control of their lives and how staff can support them to do this. One person kept taking their slippers off, wanting to walk around in their stocking feet. Staff kept putting these back on and the individual kept taking them off. The manager needs to carry out a risk assessment of this person walking around in this way and determine in their care plan how the home will support them with this choice. The menu is a three-week programme and two choices are provided for both lunch and tea. These are shown to people when they sit down to eat, so people have a visual choice. This is good practice as there is no reliance on people having to understand what the meal is. The second choice each day is often more of a snack, such as mushrooms on toast, soup or a ‘chip butty’. If people choose the second option most days then they may not be getting a wholesome diet. The manager should ask a dietician to look at the menus to advise whether the present choices provide a diet that is sufficiently nutritious. The lunch on the day of the visit was an all-day breakfast, with bacon, egg, waffles and tomatoes, or tomato soup with a bread roll. One person didn’t want either choice and decided on an egg on toast instead, which was promptly cooked for them. There was milk pudding, for dessert, with fresh fruit or yoghurt as an alternative. People spoken with said the food was very good, with one person saying ‘the food is great. I’ve always enjoyed the meals. You get plenty and get offered seconds sometimes’. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 18 There are two sittings for dinner, the first for people who can manage more or less independently. This was a social event, however as the office is positioned off the dining room there were several people, some in outdoor clothes walking through to the office whilst people were eating. This flow of people should be discouraged so that people can enjoy their meals without distraction or interruption. The second sitting is for people who need assistance with their meals. This was still going on at 2 o clock and the manager needs to monitor that lunches are given in a timely way. Whilst people were given assistance in a respectful and unhurried manner, the mealtime was poorly organised. One person with sight impairment was shown their meal options, but they said they couldn’t see them. There were no aids used, like plate guards, to promote people’s independence. Carers put protective tabards on two people half way through their meal, which meant that one carer had to get up from helping someone, to pass the protective wear to the second carer. Mealtimes need to be an enjoyable and relaxing part of people’s routines and the whole mealtime experience should be looked at to see how this could be achieved. A discussion with the cook showed that she had limited understanding of the special dietary needs of people with dementia. This was commented on in the last report, following the last inspection ten months ago. The cook did not have confirmation that s/he had completed training and had knowledge of special dietary needs of people with dementia, so that s/he can provide the right food and can know how to provide people with extra calories if necessary. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 19 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 this service experience adequate quality outcomes in this area. Whilst complaints are taken seriously and staff are alert to signs of abuse, local safeguarding protocols, in place to promote people’s safety, are not being followed. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints process is displayed in the entrance to the home, in information given to people thinking of moving to the home, and in each of the bedrooms. This is not an easy document to understand though, for people with impaired understanding, and the manager could consider producing an ‘easy-read’ version so that people have a better understanding of what they should do if they are unhappy about something. As some people living there would be unable to complain it is important that care records describe people’s behaviours and how staff would recognise whether an individual was happy or upset, so that the reasons for this can be looked into and put right. Eight out of the ten surveys received said they would tell someone if they were unhappy about something, however staff need to be alert to changes in behaviour, which may signify they are unhappy. One Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 20 person spoken with though said they would tell Emma (the manager). ‘She would sort it out’. The home has received two complaints in the past year, which both relate to care practices. The home and the local authority are still investigating one of these. The commission has received one complaint, when the complainant felt that their concerns, which they raised with the home, weren’t being addressed. Training in Safeguarding Adults is provided when people start working at the home and then annually. One staff member spoken with said they would report any incident that could be abusive, immediately to the manager. However they said that if they overheard possible abusive behaviour, they didn’t think they would intervene to check that the person was all right. The manager needs to make sure that staff know what to do in a variety of situations, so that people can be kept safe. This staff member also said they would tell the manager even if the person had asked them not to. This is good practice as staff realise that they can’t keep secrets in this situation. Two concerns raised by people not employed at Abbey Lodge, have been referred as safeguarding alerts to the local authority. The managers at the home worked with the local authority, but did not agree with some of the allegations of neglect, which had been made against the home. One of these investigations is still in progress. At the site visit the accident records were looked at. One record, earlier this year described an incident when one person was put at risk of harm, however this was not reported as a safeguarding alert to the local authority, nor was a notification sent to the commission. By not following the safeguarding vulnerable adults protocol and sharing this information, the manager is not doing all she should be doing to keep people safe. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 21 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 this service experience good quality outcomes in this area. People live in a comfortable, clean and warm home. 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 disabled access to the home and a safe garden, including patio area at the back of the property. It was noted to be warm, clean and comfortable, with no unpleasant smells. The home has a dining room, two lounges and a sitting area in the entrance hall. All except two rooms are for single use and some have en suite toilet and wash hand basin. The rooms now have locks, so that people’s privacy can be assured if they are receiving care and support there. Those rooms looked at Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 22 contained items that meant something to the person, and which made their room feel more like home. Most of the bedrooms are on the ground floor and a stair lift is used, when necessary, for those people who live upstairs. There is a bathroom upstairs, though the manager says the small number people living up there choose to use the facilities downstairs. There is a bathroom and shower wet room on the ground floor. Some of these washrooms and toilets had pictorial signs to promote people’s independence. Those signs, which were missing, were replaced during the day. The lounge where most people were sitting would benefit from some occasional tables for people to put their drinks, or personal items. The home currently uses beanbag lap trays, but tables may be more stable and more familiar to the people living there. The home employs a handyman for just a few hours each week to address basic repairs, and hazardous substances are stored safely. This contributes towards keeping people safe. The manager makes sure that appropriate aids are available and used to make sure that people living and working in the home are protected against infection. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 23 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 this service experience adequate quality outcomes in this area. Staff are well recruited and supervised but they need more guidance, support and training about the specialist needs of people with dementia, and how these needs are to be met, so that they support people properly. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Four care staff work during the day and evening. Two carers work during the night. The manager works supernumerary office hours, though works ‘on the floor’ to cover staffing shortfalls. She has had to work more care shifts in recent months. The rota generally confirms these levels, however some shifts are more than 12 hours long, so staff are likely to be very tired, both physically and mentally, by the end of the shift. The home employs five male and sixteen female care staff, there are currently three men and fifteen women living there. On the day of the site visit there were two male and two female carers. The manager said she was alert to making sure the male carers did not work together and she was aware that people’s preferences, of a male or female carer, needed to be met. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 24 The surveys completed by people, with the help of a second person, provided a range of comments to the question’ do the staff listen and act on what you say?’ These range from ‘always’ to ‘never’, with most recording ‘sometimes’. One person spoken with said the staff were ‘lovely’. And ‘they come quickly when I call them’. Although staff attend training in dementia care and managing behaviour that challenges the service, the way staff communicated with people, were generally not very positive experiences. One person with poor sight was calling out for help and appeared quite distressed. The carer had to be asked to see if they could help the person and the inspector also intervened at one point to offer support. A carer needs to be more available in the communal rooms to respond promptly to people’s needs and staffing levels need to be reviewed to make sure people’s needs can be met promptly. There needs to be a lot more talking to people or looking at reading material with people, at a level they can respond to, as this will make their lives more interesting, as well as helping to minimise their isolation and frustration. The manager supports staff to achieve a National Vocational Qualification in Care because people are more likely to receive safe, consistent care if staff understand why they are doing what they are doing. Staff turnover currently prevents the home achieving 50 of the care staff with this qualification, however the manager is aware of the need to meet that standard. Two recruitment files were looked at. These showed that people have a police check and two written references are obtained before the individual starts working at the home. This is good practice and helps to minimise the risk of unsuitable people working at the home. A staff-training programme is in place, so that staff receive both compulsory training and training related to meeting people’s specialist needs. A few of the carers have strong accents, which may make it difficult for people to understand what they are saying. The manager needs to be alert to that and make sure other staff are available to help if a person living there has difficulty understanding the accent. One comment received was ‘Some carers, whilst very nice, are difficult to understand’. Abbey Lodge Care Home DS0000044443.V373094.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience adequate quality outcomes in this area. There is a lack of proactive management and good quality monitoring schemes, which means that the home is not running as well as it should, nor in the best interests of the people who live there. 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 Commission for Social Care Inspection to manage a care home and has completed further training to help her with her role. She showed in discussion that she had a good Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 26 understanding of people’s needs and how they are to be met. People spoken with who were able to respond said they knew who she was, and saw her regularly around the home. A quality monitoring system is in place, where the home seeks the views of people, both within the home and outside, who have an interest in how the home runs. Although this information is collected, an action plan needs to be written and people need to be informed what the home plans to do as a result of these comments. This will show people that they are being listened to. The manager needs to find a way of getting the views of the people who live there. Discussions could be held to see what people like, and don’t like. One person was asked about living at the home. They replied ‘just look. They’re like stuffed people, all sleeping all the time. I think they should provide more stimulation for us here’. People’s views must be actively sought so that they can say what matters to them. The senior manager visits the home each month to carry out her own checks of how the home is running. The manager carries out her own regular checks to make sure people’s health and safety is being protected. Since the random inspection in September 2008 she has carried out more checks on the way medication is managed. However neither she nor her manager have addressed the untidiness and clutter that is evident in the medication room. This was to be dealt with in the days following the inspection visit. Two people’s monies were looked at. The money is securely stored, but only the manager and her manager have access to it. This means that if people want some money when the manager isn’t at work, then staff have to contact her to come to the home. Whilst paper records and receipts tallied with the actual monies the manager could look into how people could have some of their money whenever they asked for it. 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 training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. However the manager should make sure that staff receive this training from a trainer who has been trained as competent in each subject area. This makes sure that staff are given the right information. People living at the home need an 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. Those people with a hearing impairment may not hear the fire alarm at night, and the manager needs to have systems in place to alert them, in such an event. Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 27 Hazardous products are stored appropriately and records maintained as required. Monitoring arrangements are in place to ensure the delivery of safe hot water. Fire safety checks are carried out regularly. A random number of safety certificates were checked and found to be in date. Maintenance of these systems are in place to keep people safe. Abbey Lodge Care Home DS0000044443.V373094.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 1 9 1 10 1 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Abbey Lodge Care Home DS0000044443.V373094.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 OP7 Regulation 15(1) Requirement Timescale for action 28/03/09 2. OP8 13 3. OP9 13 All people should have a comprehensive plan of care, including their photograph, written in a way that recognises their ability, however small, to contribute to their care and maintain some control of their lives. This will enable people to be supported in a safe, consistent way. There must be confirmation that 28/02/09 guidance has been sought from healthcare professionals when risk to health is identified. If the individual chooses not to follow that advice, then more advice must be sought. Guidance about the care of people with specific health conditions must be obtained, so that good quality support can be provided. This will help to make sure people’s general health is being well managed. Written advice must be sought 28/02/09 from the pharmacist about the named person’s drugs, which are given hidden in food so that the individual will take them. This is to comply with the home’s DS0000044443.V373094.R01.S.doc Version 5.2 Abbey Lodge Care Home Page 30 4. OP9 13 5 OP9 13 6. OP10 12(4) 7. OP14 12(2) 8. OP15 16(2) 9. OP18 13 medication policy and to check that the drugs will still work effectively. Medicines must not be carried around the home in someone’s pocket. This is unprofessional and the medicines belong to the person for whom they are prescribed. A system must be in place to record medication carried over from the previous month’s medication record to the new one. This helps with auditing that medicines are being given as prescribed. People must not receive personal care in a communal area. This must be carried out in their own room, where their privacy and dignity can be respected. People must be supported when they make positive choices and decisions, about their day-to-day lives. This choice needs to be risk assessed and recorded in their care plan. This will enable people to stay in control of their own lives as much as possible. The manager must show the home’s menus to a dietician to check that someone regularly choosing the ‘alternative’ menu is still receiving a varied and nutritious diet. The manager must inform the local authority promptly of any incident of abuse at the home. The commission also must be informed. The sharing of this information and following local vulnerable adults guidelines will help to keep people safe. 28/02/09 28/02/09 28/02/09 28/03/09 28/02/09 28/02/09 Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 31 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 OP9 Good Practice Recommendations The temperature of the fridge should be regularly monitored and the fridge regularly cleaned and defrosted. This makes sure that medicines are being stored at the temperature recommended by the manufacturers. The whole dining experience should be reviewed. This includes: a) Restricting the flow of unnecessary people walking through the dining room to the office b) People are provided with protective wear before they start eating their meal. This will help to promote mealtimes as relaxing social occasions. Handwritten entries and changes to medication charts must be accurately recorded and signed and dated. A second person should sign to say they have checked that the written details are correct. This makes sure that the correct information and dose is recorded so a person receives their medication as prescribed. The way staff work in the home should be reviewed to see if a carer can be more available in the communal areas to respond to the needs of the people in a more timely way, and to anticipate their needs before they become upset. The home should continue to strive towards achieving 50 of the care staff having a National Vocational Qualification level 2 Award in Care, so that care can be provided by staff who have a greater understanding of their role. 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. 2 OP15 3. OP19 4. OP27 5 OP28 6 OP30 Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 32 7 OP33 The manager needs to look at ways how she can obtain the individual views of people living there so that they can have a say in how the home runs. There should be some consideration given to having a system at the home where people can access some of their own money, whenever they want it. This will provide people with more choice and control of their finances. 8 OP35 Abbey Lodge Care Home DS0000044443.V373094.R01.S.doc Version 5.2 Page 33 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 Textphone: 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. 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