CARE HOMES FOR OLDER PEOPLE
Abbey Lodge Residential Care Home 91 Seabrook Road Hythe Kent CT21 5QP Lead Inspector
Lois Tozer Unannounced Inspection 10:15 16 January 2007
th 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 Residential Care Home DS0000059725.V300659.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 Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abbey Lodge Residential Care Home Address 91 Seabrook Road Hythe Kent CT21 5QP 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) 01303 265175 www.abbeyresthome.co.uk Abbey Lodge (Residential Home) Ltd Mrs Elizabeth Caroline Bown Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users with a diagnosis of DE(E) to be restricted to one (1) whose dates of birth is 24/12/1920. 16th January 2006 Date of last inspection Brief Description of the Service: Abbey Lodge provides accommodation and personal care for up to 18 Older People. The premises are detached and have 16 single and 1 double bedroom. Fourteen of the bedrooms have en-suite facilities. Accommodation is on the ground, first and second floor. There is a shaft lift servicing all floors and also a stair lift. Three bathrooms are available for service users use, two of which are assisted. There are communal sitting areas on all three floors allowing service users a choice of where to sit. Staffing numbers is based on service users support needs. One of the proprietors (Mrs Elizabeth Bown) manages the home and has gained the NVQ Level 4 qualification in management and care. The Home has achieved the Investors in People award. Previous inspection reports are available from the home. The weekly fee currently starts at £318.35 rising to £460.00. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key site visit took place on 16th January 2007 between 10.15 am and 4pm. The manager, Mrs Elizabeth Bown, was on holiday, so the deputy took charge of the visit. Service users and staff also assisted with the process. Sixteen people live at the home at the moment. Five people gave feedback through questionnaires and four people gave their impressions in person. Three care plans were ‘tracked’ and these formed the basis of the inspection. All communal areas of the home and some private rooms were seen. Residents were happy to discuss their experience of living at Abbey Lodge. All were very happy and made it clear that they would not choose to live elsewhere. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota, complaints and fire logs. What the service does well:
The management team involve the residents in the planning and development of the home. When changes are planned, residents are fully consulted. Residents can see that their suggestions are put into action. The care planning system is very good. It is written from the pre-admission assessment, which is conducted in consultation with the potential service user. Independence and enjoyment of life are encouraged. People living at the home choose to get involved in activities if they wish. The majority of people have large rooms. They are able to furnish the rooms with their own furnishings if they wish. The communal areas are very well decorated and furnished. The home is warm and comfortable. Alcoves have been used creatively to make quiet areas and libraries. An extension is being built at the moment. This has been sensitively planned to have the least disruption for service users. There are activities available within the home. Staff offer the opportunity to all residents to join in. Regular trips by car to the local shops are organised. Every resident spoken to during this visit complemented the home and said they would never choose to leave. One resident said “I walked in here with my Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 6 care manager and immediately said ‘This is the place for me’. Its just like home, not a care home, but my home”. Residents know that they can complain and feel confident to speak to staff about any issues. All staff feel valued and confident to speak up if they felt there were any issues of concern. Domestic staff demonstrated clear awareness of adult protection issues, showing that all staff are valued and given developmental opportunities. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users know that the home will meet their needs. People are not admitted for intermediate care. EVIDENCE: Pre admissions assessments take place before people move into the home. They are thorough and explore health and social needs. These have been conducted with the individual, who, if able, will sign them off. Family, social workers and friends have been involved. The home collects a good level of historic information about the person, so staff are able to really get to know the person. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 9 Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The plans are clearly written. They express how each person needs and wishes to be supported in all aspects of social and health care. Self-administration of medication is encouraged. Centrally administered medication is generally well managed, but some improvements would be beneficial. People are treated with dignity at all times. EVIDENCE: Care planning is written and reviewed, where possible, with the service users. The information covers individuals personal and social care needs, and is expressed in a helpful and sensitive way. Using these documents, staff are able to support people in the right way. Plans are reviewed each month with, where possible, service user input.
Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 11 Health care is very well supported, and these notes are clear and easy to follow. Where necessary, care plans have been amended to take into account changing needs. Accurate records are maintained to monitor pressure areas and skin condition, weight, socialisation and behaviours that may indicate a changing health need. There is a simple and effective medication system in place. Service users are assessed to see if they can or want to self medicate. Staff are sensitive and discreet when administering medication. There is a training system in place, where staff must demonstrate their competency. Some gaps in the medication administration records (MAR) had not been queried. This causes uncertainty as to the staff action and if the service user took the medication. This needs to be improved through regular auditing and including such scenarios in the competency assessment framework. A copy of medication returns should be retained on the premises and specimen signatures would benefit from being comparable to those used on the MAR sheet. Storage of medication is set to improve with the current building work, such as a dedicated fridge and a bigger working space. Service users said that staff treat them with dignity. Observations during the visit showed that this was the case. Care plans make clear how individuals wish to be treated, and amenities, such as private telephones, are installed into bedrooms as required. Service users were highly complementary about all staff. They made it clear that nothing was any trouble and that they felt they could speak up about anything that bothered them. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home meets the lifestyle expectations of service users. Family and friends are very welcome and, along with staff, support service users remain in control of their lives. Meals are prepared to meet individual needs and to a consistently high standard. EVIDENCE: People choose what level of activity they have. Most days, there is a communal activity, such as exercises to music. There are several places where service users can sit and read, or listen to music, such as a library in the middle of the home on first floor. Staff keep records of activities, and review what is and is not popular. A service users said that there is ‘enough to do, its not a boring place to be’. One complemented the owner on organising weekly trips to the local shops. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 13 Family and friends are very welcome to visit. Several service users said that they came to live at Abbey Lodge because they were so welcomed when visiting. People who have moved in from a home that recently closed keep in contact with their friends, who are welcomed. Routines are flexible and residents are able to take part in the life of the home where they wish. People who want to join in the running of the home can do so. The manager and staff consult with all residents about change. People have said how they want parts of the new extension to impact on the home, and this has been incorporated in the plans. Access to the kitchen is open to all. General social contact with cook is encouraged. There is a table in the corner of large kitchen for this purpose. The meals in the home are excellent, offering both choice and variety. A wide range of food is offered, and service users say that they always or usually like the meals. Particular likes and dislikes are known to the staff and cook. Special diets and preferences are know and catered for. Individual likes for particular brands or types of tea are supported. There is a tea making station on the 1st floor, in the library, for people to use. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and acted upon. Staff make sure service users are protected from abuse. EVIDENCE: Staff are clear on the action that must be taken should a service user or family member make a complaint or if a matter of protection arises. The internal log shows that all matters are taken seriously and resolved. Observations during the visit showed that residents had no hesitation to ask for help, or make a problem known. Staff are clearly open and approachable, ensuring that complaints will be heard. Adult protection training is given. Staff complete a knowledge based competency assessment on a semi regular basis. Service users said that they feel safe and would recommend the home to anyone. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is safe, hygienic and well maintained, protecting service users. The layout and planned changes are well thought out, and consider service users views. EVIDENCE: The home is undergoing some big changes, with a large extension being built at one end. Although this has caused some disruption, it has had a minimal impact on service users. Consultation on the development has taken place with all. Those most effected had lots of time to adjust. The manager has spoken to residents and incorporated their views into the development, for example the position of the front ramp; that they want to turn left out of the front door to sit on the bench at the front. This is being incorporated. The new bedrooms and bathroom are very well designed, and maximise independence and space. One service user stated ‘This is a real home – not a
Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 16 care home.’ The home is warm and cosy throughout and the kitchen remains available for service users to enter and make drinks. Small communal areas are dotted about on each floor. There is a drink making facility within the library on the first floor. The laundry is currently sited in a temporary shed to the rear of the house. This has all the necessary fittings for infection prevention. A dedicated sluice area is being incorporated in the new build. There are no unpleasant odours. Domestic staff pride themselves in keeping the home spotless. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff that are competent and are available in sufficient numbers meets service users needs. There is an effective training programme in place. The recruitment process protects service users from harm. EVIDENCE: The mixture of staff on duty reflects a good balance between new and established members. Domestic and catering staff provide additional support. There is always a manager on duty or on call day and night. A sleep-in staff member, who is on call, supports wake night staff. Recruitment follows the correct procedure and staff benefit from a skills for care induction. Staff training is provided to meet service user needs. Over 50 of staff holds an NVQ2 or better qualification. The manager and deputy are training facilitators for many courses. There is always a staff member with current first aid training available. Staff have regular direct supervision, and formal meetings with the manager, which is documented, a minimum of four times a year. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 18 Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from a very well run home where they have a real say in the service provided. Individuals’ finances are safeguarded. Health and safety is well supported. EVIDENCE: The manager has many years care experience and holds up to date qualifications (NVQ 4 and Registered Managers Award (RMA), as well as being a trainer for many topics. Competent and well-trained staff carry out
Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 20 delegated responsibilities. There is a system of keeping up to date with modern care practice. Good networking links with healthcare professionals are in place. The home is well run, and very much in consultation with the service users. The manager focuses on the achievement of excellence and works with Investors in People to make sure staff hold the same values. There is significant liaison with healthcare professionals, and this advice and support is incorporated into the day-to-day running of the home. There is a welldeveloped quality assurance programme in place. Staff, service users and their families have formal input by way of meetings and questionnaires. Service users views are taken seriously. Future plans and development are in conjunction with service users views. Two important areas need greater auditing; these are fire alarm system checks and the monitoring of medication practice. Any small amount of money held on behalf of service users is clearly documented and accountable. No person working for the home has control of service user finances. Individual possession lists are in place for each service user at the point of taking up residence. All domestic service certificates are up to date. The fire fighting equipment is regularly serviced, but recently the ‘in-house’ checks have stopped. Staff have up to date health and safety training and the gaps in the team skills are quickly put right. Fire risk assessing has been reviewed to take into account the change in the environment and that builders are on the premises. The new fire precautions and risk assessment legislation was discussed. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 21 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 4 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 X 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement To ensure all service users are protected, medication administration must be clearly recorded, and gaps be followed up. Timescale for action 01/02/07 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 OP38 Good Practice Recommendations To protect staff and service users, fire warning systems should be checked on a regular basis. Abbey Lodge Residential Care Home DS0000059725.V300659.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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