Inspection on 22/11/07 for Abbey Rose

This inspection was carried out on 22nd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Rose 08/02/07

Abbey Rose 17/07/06

Abbey Rose 10/01/06

Abbey Rose 25/07/05

Abbey Rose 13/01/05

Abbey Rose 31/08/04

Abbey Rose 05/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Abbey Rose [previously Varndean House] Cedar Avenue St Leonards Ringwood Hampshire BH24 2QG Lead Inspector Debra Jones Key Unannounced Inspection 22nd November 2007 09:40 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 Rose [previously Varndean House] DS0000038431.V355392.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 Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbey Rose [previously Varndean House] Address Cedar Avenue St Leonards Ringwood Hampshire BH24 2QG 01202 877764 01202 874624 abbey.rose@hotmail.co.uk 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) Mrs Audrey Martha Watts Mr John William Watts Mr Mark Burchfield Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2007 Brief Description of the Service: Varndean House operated as a care home since 1983. The name of the home has recently been changed to Abbey Rose and it is now accessed from Cedar Avenue. The home is owned Mr and Mrs Watts and is managed by Mr Mark Burchfield. Abbey Rose is a large detached property that has been extended over the years to provide good-sized bedrooms and communal spaces for the residents. Mr and Mrs Watts have made a substantial investment in the home with regard to redecoration and refurbishment. The home is registered to accommodate a maximum of 18 service users in the category of OP (older people) for personal care; the home is not registered to provide nursing care. Accommodation is provided on the ground and first floor levels with a communal lounge, sunroom, dining room, kitchen, laundry and communal bathing and toilet facilities. Bedrooms are on the ground and first floor and many have en-suite facilities. The first floor is reached by a passenger lift. Abbey Rose is close to the village of St Ives, which provides local shops and post office. Ringwood, a small market town, is approximately 2 miles from the home, accessible by local buses. The larger towns in the area, Bournemouth, Ferndown and Poole are also easily accessible by public transport. Fees range from £335 - £500. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place on 22 November 2007. Debra Jones was the inspector who carried it out. Mark Burchfield (Registered Manager) and the staff of Abbey Rose helped the inspector in her work. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting the requirement and recommendations made at the previous inspection. The inspector was made to feel welcome in the home throughout the visit. A tour of the premises took place and a variety of records and related documentation were examined, including care records. Time was spent talking with 5 residents privately in their bedrooms and in the lounge. The requirement made at the last visit was carried over in part. The 3 recommendations made last time had all been met. Three new requirements were made and 2 recommendations. Some good practice suggestions were discussed at the inspection and these are referred to below in the summary, intended to encourage improvement in the service. During the course of the visit residents talked about the good food, the standard of cleanliness and their fondness for staff in the home. Comments included:‘Staff are very helpful if you want anything.’ ‘It is the next best place to home.’ ‘The manager is a very thoughtful nice man. They will do anything for you it is very good.’ ‘I am happy here.’ ‘It is an easy life here.’ ‘I love it.’ ‘The manager is really nice.’ ‘They have made a good job of the building works.’ ‘I’m fine, everything is good; the food, the cleanliness and the attention.’ ‘Everybody is so kind. I don’t have to worry about anything.’ Prior to the inspection the home submitted to the Commission a completed annual quality assurance assessment (AQAA). This gave information about the service and the home’s performance. This document was also helpful in the planning of the inspection visit. The home also sent out comment cards on behalf of the Commission; two were returned; 1 by a relative and 1 by a care manager. When asked ‘What do you feel the service does well?’ the responding relative said ‘Cares for their service users and feeds them very well. ‘It is a very nice place and all the staff and management are very professional and friendly.’ Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 6 In answer to the same question the care manager said ‘The management and staff make residents and visitors welcome. The atmosphere is friendly and light hearted. Residents are well cared for treated with respect and dignity. Staff listen to them when they have problems or want someone to talk to. This residential home feels like home it is not sterile or institutionalised.’ What the service does well: What has improved since the last inspection? Records of care given by Chiropodists and other care professionals that visit the home are now kept and so demonstrate that this area of care is addressed. Recruitment practices have improved and staff now only start working in the home only after they have had a satisfactory Protection of Vulnerable Adults list check and are only confirmed in post after receipt of a satisfactory Criminal Records Bureau check. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 7 Where the home holds cash for residents, when a transactions takes place the resident as well as a staff member are now signing the record to confirm. When the resident is unable a second staff member signs instead. What they could do better: Currently the home does not inform people that when the fees at the home go up that they will be given at least one months notice. Knowing this would help people decide whether they are getting the service they chose at the price they expected and to forewarn them of any increases in the amount they have to pay and be clear about the reason for any increase. Pre admission assessments do not cover all the suggested areas of need listed in the national minimum standards and so the full range of people’s needs are not being considered prior to them moving to the home. The care planning system is not currently effective enough to ensure that staff have the information they need to meet the health and personal care needs of residents and needs to be improved. Recruitment procedures need to be more robust to make sure all checks of documentation as required by law are undertaken so that only suitable people work at the home. In addition to the 4 requirements and 2 recommendations made in this report the following good practice suggestions are made that the home are urged to adopt and act upon. The home is encouraged to • Date all information coming to the home that relates to residents e.g. assessments and reviews from local authorities. • Obtain the clinical triggers available on the CSCI website in respect of continence, dementia care, prevention of falls, pressure area care (tissue viability) and nutritional care (incorporating the malnutrition universal screening tool). • Obtain the Medicines and Healthcare products Regulatory Agency device bulletin on the safe use of bed rails in order to carry out bed lever assessments and risk assessments. • Replace the metal box used to store medicines in the fridge with a lockable plastic one. • Make a distinction between medicines prescribed as when required and the same medicines given by the home as homely remedies e.g. paracetamol on the medication administration records. • Add to policies and procedures advice to staff as to how they are to clean and dry commodes and bottles in the home. • Check that residents in rooms with light panels are happy that these panels are not covered and to cover them if they wish. (the views of new residents should be sought before moving into these rooms in future.) • Attend Mental Capacity Act training Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 8 • • • Expand their annual quality assurance system to seek views of stakeholders as well as residents and relatives e.g. GPs, nurses, care managers, health professionals etc. Improve accident records by consistently noting if accidents were actually seen by the person completing the report form or if residents told them what had happened. Carry out fire drills / training from time to time at night. 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 Rose [previously Varndean House] DS0000038431.V355392.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 Rose [previously Varndean House] DS0000038431.V355392.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): 2, 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there is a pre admission procedure is in place and assessments are being routinely undertaken they are not comprehensive enough to fully ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Documentation for two residents was examined as part of the case tracking procedure used during this inspection. Both had been admitted to the home since the last inspection. Pre admission assessments were on file for both of them. The needs of prospective residents are assessed using a prescribed format that the home has developed to encompass health and welfare needs. However the form does not prompt the assessor to explore all the areas listed in the National Minimum Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 11 Standards and so these were not assessed e.g. the persons diet, weight, dietary preferences, oral health, foot care, history of falls, medication usage and social interest were not noted. The home puts in writing to the person they have assessed that they can meet their needs. Residents are issued with a contract by the home. It does not include that a months notice will be given before any fee increases. Abbey Rose [previously Varndean House] DS0000038431.V355392.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that resident’ healthcare needs are met through seeking appropriate input from GPs and other healthcare professionals. Residents feel that their privacy and dignity is respected. Shortfalls in care plans and managing medication put the health and well being of residents at some risk. EVIDENCE: The information contained in pre-admission assessments is used to help draw up care plans. In some cases the home receives additional information relating to residents e.g. from local authorities, hospitals. Such information is not dated as to when it is received at the home. Plans were seen where residents had signed to say that they agreed with their content and a system was in place to show that they were reviewed regularly. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 13 Five care files were reviewed at this visit. The home carries out some basic assessments when people arrive at the home e.g. risk assessments for falling, nutrition and pressure sores. These were seen on all but one file. Another file had the assessments in place but no care plan. The manager said that this was an exception and all other residents had a care plan in place. Care plans were similar to the pre admission material in that a prescribed format was in place that did not cover all the areas needed to be considered to fully meet the needs of residents and specific and individual needs were not planned for in all cases. Care plans were written in such as way that they were mixture of assessments and outcomes with some information about how the home were to meet needs. It was therefore not clear which areas of need the home actually needed to plan to meet for each individual and what staff were to do on a daily basis. Significant information was noted in documentation e.g. the daily notes, assessments etc from local authorities, which had not been added to the care plan. One resident was recorded as having suffered a series of falls since their arrival in the home, mostly in their own room. The plan from the local authority said that they were ‘unable to transfer without the assistance of one person’ and that they were ‘prone to falls.’ The homes own care plan made no reference to this, a falls risk assessment was not in place, and no plan was in place as to how to minimise the risk to the person of falling. Another resident was noted as having lost her balance in the dining room. Daily notes included the instruction ‘please walk with xx and a her to and from the dining table.’ This instruction had not been transferred to the care plan. Another resident was noted as having a heart problem and the visiting doctor gave this as the reason as to why her feet and ankles were swollen. Information as to how the home was to meet the residents’ needs in this respect to minimise future swelling was not included in the plan. Care plans do not include information about the persons’ social needs other than having visitors, taking papers and comments such as ‘x is a sociable person’. There was nothing about how the home was to meet any social needs. Another resident has diabetes. Their care plan says that they are diabetic in the eating and drinking section of the care plan and that their diabetes is medication controlled. The care plan was not clear about what the home had to do to support the resident to manage this condition. Daily records are maintained, although they are not written daily. The manager said that they were used to note things that were out of the ordinary. These notes help evidence the delivery of care to residents and should feed into the regular reviews of care plans. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 14 The care plans do not include sections on medication. One resident was given paracetamol as a homely remedy. The home’s policy said that this was not to be given to residents in certain circumstances e.g. if they had a kidney problem. On looking through the residents’ notes a reference was made as to them in their medical history provided by the hospital as having a kidney problem. This was not in the care plan. Evidence was available on file and through discussion with management that GPs, district nurses, opticians and chiropodists are available to residents. Some residents have aids to help them retain their independence and to assist them with their mobility. A couple of residents have bed levers to help them out of bed. Assessments and risk assessments for these items were not on file. Files referred to them as cot sides, which they are not. Some residents have equipment to help keep their skin in tact, such as pressure relieving cushions. These too need to be part of their care plan and for those care files seen they were not. Community nurses regularly visit a couple of residents for pressure wound care. Staff were clear verbally as to what they were to do for the residents between the nurse visits and daily notes reflected the care they gave, but care plans did not include this information. Medicines prescribed by doctors are safely stored and administered to residents only by staff who have received training in this work. Medication administration records (MARs) sampled were up to date and properly completed as to medicines received and administered. Any allergies known are clearly recorded, and where there are none known this is also noted. The home completes their own medication administration records, rather than receiving printed ones from a pharmacist. When they are first completed they are countersigned by another competent person to confirm accuracy. However when additional entries are made they are not countersigned. Most medicines are delivered to the home in bottles and packets. Some were sampled as to whether the numbers of tablets agreed with the records, a few sampled were out by one and no explanation was available as to why this was. The home has a controlled drugs cupboard and register where 2 staff sign whenever such a drug is administered. Balances are now noted, as recommended at the last inspection visit, and these matched the medicines on the premises. The fridge where medicines are stored is regularly checked for temperature. A lockable metal box is used to store medicines in the fridge, although none are currently being stored. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 15 The home has a system for returning unused medicines to their pharmacist and appropriate records are kept. The home carries out self-audits of medicines on the premises every six months and written explanations are noted where there are discrepancies. A ‘sample signature’ (initials) sheet is held on the medication records file so anyone can tell at a glance who administered medication at any time. Some residents are prescribed medicines to take ‘when required.’ In all cases the manager said that residents are able to make the decision as to when they want these medicines. Where medicines are prescribed in this way the home makes a distinction on the medication record by putting it in a different colour. The home are also adding entries to these records when homely remedies are administered, but it is not clear from the records which ‘when required’ medicines are prescribed or not, this was particularly in respect of paracetamol. Due to the way the home were administering paracetamol it was not possible to tell how many tablets should be on the premises as there was no balance kept for the paracetamol used as a homely remedy and the prescribed ones were not always issued from the boxes delivered to the individuals who were taking them. A pill counter has now been obtained to enable safe counting of tablets without risking contamination. One resident talked about how the home looked after their medication for them and brought the medicines to them when they were supposed to. Residents confirmed that they were treated with respect and kindness ‘absolutely’ and their right to privacy was upheld. Staff were seen to knock on doors and performed their tasks discreetly and politely. The name that residents like to be known by is noted on their care notes. Clothes are marked with names on admission to assist the laundry. All residents have a lockable area in their rooms for their use. All residents currently have their own rooms and can see friends, relatives and visiting professionals in private. Abbey Rose [previously Varndean House] DS0000038431.V355392.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some activities are available for residents to participate in should they choose to. People are generally encouraged to make choices about their life style and to maintain contact with their family and friends. The meals in this home are wholesome and varied, and are served in a pleasant dining area. EVIDENCE: Varndean House provides occasional organised activities such as concerts from visiting musicians and singers. The home has purchased a number of games such as bingo, large sets of dominoes and connect 4 and various local interest books. In addition the home has a wide selection of CD’s and videos/ DVDs. One resident commented that they thought that activities could be better e.g. more to do. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 17 During the day residents spend time in their own rooms or with other residents in the communal areas. Residents also talked of going out with families and friends and generally of how they liked to spend their days, e.g. playing cards and watching good TV. The local library service visits the home regularly as does a hairdresser. An exercise session takes place fortnightly. Visitors are encouraged to visit the home at any time. Residents records and the visitors’ book demonstrate contact with family and friends as well as visits from professionals. Information about advocacy services are on display in the main hall. People are encouraged to pursue their own lifestyles within the home and make individual choices wherever possible. These include choosing when to get up and go to bed, what to wear, what to eat and drink and to generally do as they wish during the day. Many bring their own possessions into the home and personalise their bedrooms, as was seen when the premises were toured. The home has a 4 weekly menu, which shows the choice of meals available. There are two roast dinners served every week and there is always fish on Fridays. No special diets are being catered for presently, aside from low sugar diabetic. Food supplements are available for those not eating well. Lunch on the day of the inspection was toad in the hole served with carrots, and swede mash, cabbage and potatoes, followed by pear and chocolate custard. Records showed that alternatives are available. Practically all the residents currently living at Abbey Rose have their meals in the home’s dining area; they could have them in their own rooms if they chose to. Everyone spoken to said that the food was to their liking. Comments from residents at the visit included: ‘The food is good – I get what I like.’ ‘The food is lovely; nicely presented, nicely cooked and the food I like to eat.’ Abbey Rose [previously Varndean House] DS0000038431.V355392.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a complaints procedure. Policies and staff training in abuse protect residents from harm. EVIDENCE: Residents spoken with at the visit were clear about who they would complain to should they need to and that they felt confident in raising issues with staff and management. They all said that they had nothing to complain about for now. No complaints have been received by the Commission for Social Care Inspection since the last inspection. The complaint received by the home was responded to in writing within the home’s published timescales. The home has an adult protection policy, that shows that they are committed to following the Dorset guidelines, based on the Department of Health ‘No Secrets’ document, should there be any allegations of abuse. There is also staff training in this subject at the home from induction onwards. The manager reported that staff had either done a training course in adult protection or were booked to do so. Prior to any members of staff commencing employment at the home the Protection of Vulnerable Adults list is checked to ensure their suitability. Abbey Rose [previously Varndean House] DS0000038431.V355392.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 16 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment is excellent providing residents with an attractive, comfortable yet homely place to live. Bedrooms are decorated, furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the people living there. The home is kept clean and smells fresh thereby making daily life for all in the home more pleasurable. EVIDENCE: At the last inspection it was noted that another phase of major building works had commenced ‘which will result in more bedrooms, a through floor passenger lift and improved communal areas. A new kitchen, hairdressing room and staff area has already been completed.’ Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 20 The building works are almost complete and there is now an excellent standard of accommodation for residents. The home have applied to the Commission to register a further 6 bedrooms. Residents talked of how pleased they were with the result of the building works and decorations, and of how very glad they were that the building works were nearly over. The expanded lounge, dining area and sun lounge are all comfortably furnished. There are new carpets throughout. The chiropodist also uses the new hairdressing room. All bedrooms are currently singly occupied and most have en suite facilities. Four rooms on the first floor have light panels that allow natural daylight into the hallways. In these rooms residents do not have full control over the light in their rooms, e.g. when a light is on in the hallway light comes into their rooms. Residents have not been asked if they wish these panels to be covered. There are a number of communal bathing areas in the home, one has been refurbished and there is also a new bathroom on the first floor. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. All residents can have a key to their bedroom door. There is now a passenger lift in the home, enabling easy access between the floors. There are emergency alarm bells throughout the home – in each bedroom and in communal areas. ‘If I ring they are here.’ (a resident) All laundry is done on the premises. The laundry was visited and was clean and tidy. The laundry has a hand wash basin and appropriate liquid soap and paper towels to promote good infection control. Policies do not currently include directions for staff as to how they should clean and dry commodes or bottles. Residents spoken with at the visit said that they were generally satisfied with the standard of cleanliness in the home, with the personal laundry service and with bed changing arrangements. ‘You leave things out at night and they are back the next day, clean and ironed.’ The manager talked of the steps they were taking to improve the labelling of clothes to ensure that personal laundry got back to the right people. Abbey Rose [previously Varndean House] DS0000038431.V355392.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained care staff are employed and deployed to meet the care needs of residents. However residents are not currently fully protected from harm by the home’s recruitment procedures. EVIDENCE: Rosters show that the home maintains adequate staffing levels to meet the number and needs of residents currently living at Abbey Rose. Two care staff are on duty 24 hours a day with a senior carer and the manager on hand daily to support them. In addition the home employs cooks and cleaners. More staff are available at peak times of day. Staffing rosters show who is on duty at any time and what jobs staff are doing e.g. cook / cleaner etc. A relative who returned a comment card to the Commission before the inspection said ‘staff are approachable and the residents have a good relationship with them.’ The manager confirmed that eleven members of care staff currently work at the home. Two members of staff currently possess a National Vocational Qualification in Care (NVQ) at level 2, one at level 4 and 2 at level 3. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 22 Recruitment records were viewed for three members of staff who had started working in the home since the last inspection. Most documents that should be on file were. Prospective staff complete an application form and are interviewed. The files seen included proof that the home had checked that the prospective member of staff was not on the Protection of Vulnerable Adults list, held by the Department of Health, before they started working at the home. Criminal Record Bureau disclosure certificates were also on file. References had been also been received, although one had been written prior to the person approaching the home for work and the home had not got proof that they had checked it’s authenticity. Files contained proofs of identity that were photographic. Files did not contain full employments history or written reasons for the gaps. Though files contained medical histories there was not a statement by the person that they were physically and mentally fit to do the job. New staff undertake induction and foundation training based on those provided by ‘Skills for Care’ – the industry standard. Records are kept of staff training. No one at the home has attended training on the new Mental Capacity Act. Abbey Rose [previously Varndean House] DS0000038431.V355392.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, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Solid management practice, systems in place, and records kept, confirm the health and safety of people in the home. EVIDENCE: Mr Burchfield has obtained the registered managers award and the National Vocational Qualification at level 4 in care. He also has the relevant experience to manage a home of this nature and size. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 24 Prior to this inspection the home completed an annual quality assurance assessment (AQAA), which they submitted to the Commission for Social Care Inspection. This identifies what the home feels they do well and sets out their plans for improvement over the next twelve months. The home sent out and made available comment cards for the Commission as requested before this visit. Comments came back from 1 relative and 1 care manager. Both were generally positive about the home. The home also has their does quality assurance system and regularly gives questionnaires to residents and relatives to find out more about what people think about the home. They are not currently seeking the views of other stakeholders e.g. care managers, health professionals. Those recently received were very positive about the home and the services delivered at the home. The only negative comments were around the building works, which are now nearly complete. The home encourages residents to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home say that they ensure that either family or other representatives such as solicitors take on this role. The home holds small amounts of cash for some residents. Residents’ monies held by the home are securely and individually stored. At the last visit it was advised that all entries in records of amounts held should be signed and verified by two people. This has been addressed. Monies held for two residents were checked and corresponded with their balance sheets. Receipts for money spent are also kept with residents’ money. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. Practices at the home are underpinned by a range of policies and procedures which the home confirmed were recently updated. The home’s fire risk assessment was seen. This was last reviewed in June 2007. At this time no new fire risks were identified that needed to be addressed. Staff fire training and fire drills are frequently carried out to ensure all are fully aware of what to do should a fire break out. Fire training and drills usually take place during the day. Appropriate records are kept of the regular internal and external checks of fire safety equipment maintenance. Accident records were looked at. These were generally well completed. Not all were clear as to whether accidents were actually seen by the person completing the form or if residents told them what had happened. Appropriate notifications about incidents and accidents are made to the Commission as required by law. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 25 Information sent to the Commission prior to the inspection confirmed that the home is undertaking appropriate checks of equipment and facilities at appropriate intervals. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5a Requirement The registered person shall notify the resident at least one month in advance of any increase in the fees payable for the provision of care home services. Timescale for action 01/01/08 2. OP7 15 01/01/08 Care plan documentation must include how the residents’ health and welfare needs are to be met. These must be individual and relevant to the resident and include where appropriate falls risk assessments and how identified risk is to be minimised; meeting moving and handling needs; how the home are to provide care following advice from health professionals and between regular visits; diabetic care; significant medical histories. Care plans must include how the social needs of the resident are to be met. Assessments must be in place for equipment such as bed Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 28 levers. The need for and use of pressure relieving equipment must be noted in the care plan. 3. OP9 13 Homely remedies must only be given after ensuring that they are suitable for the person to take. All handwritten entries on Medication Administration Records (MARs) must be signed, and countersigned by another competent person, to confirm their accuracy. Balances of actual medication must match records. Only medicines belonging to individuals are to be given to them, with the exception of homely remedies purchased by the home. A system must be put in place to track the balance of homely remedies kept in the home. 4. OP29 19 The registered persons must 01/01/08 ensure that all persons employed are fit to work in the home. The registered persons must obtain in respect of each person the documents listed in schedule 2 of the Care Homes Regulations 2001 e.g. full employment history, a statement by the person as to their mental and physical health. In addition the home must be satisfied as to the authenticity of the references and information received. (Carried over in part from previous reports) Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 29 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP12 Good Practice Recommendations All areas listed in this standard should be assessed as part of the pre admission assessment. Residents’ interests should be recorded and they should be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities. Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. Extracts may not be used or reproduced without the express permission of CSCI Abbey Rose [previously Varndean House] DS0000038431.V355392.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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