Inspection on 28/06/07 for Abbeycrest Nursing Home

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Abbeycrest Nursing Home 09/05/06

Abbeycrest Nursing Home 11/10/05

Abbeycrest Nursing Home 19/07/05

Abbeycrest Nursing Home 15/11/04

Abbeycrest Nursing Home 18/05/04

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

CARE HOMES FOR OLDER PEOPLE Abbeycrest Nursing Home Essex Way Sonning Common Reading Berkshire RG4 9RG Lead Inspector Delia Styles Unannounced Inspection 28th June 2007 10:00 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 Abbeycrest Nursing Home DS0000027139.V342167.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. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeycrest Nursing Home Address Essex Way Sonning Common Reading Berkshire RG4 9RG 0118 9724414 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) Abbeycrest (Reading) Limited Mrs Lesley Jacqueline Wright Care Home 24 Category(ies) of Learning disability (2), Old age, not falling registration, with number within any other category (24) of places Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. The total number of persons accommodated must not exceed 24 The above LD category relates to two named individuals and CSCI will need to review any changes to the above 9th May 2006 Date of last inspection Brief Description of the Service: Abbeycrest is situated at the edge of Sonning Common village, near Reading. It provides accommodation and care for a maximum of 24 older people who require general nursing care. The building was originally a school and was converted for use as a residential care home in the 1980s. It is within reach of a local bus service, village shops, a library and the doctors’ surgery. Residents’ accommodation is provided in 14 single and 5 shared (double) rooms. All rooms are equipped with a washbasin. none of the rooms has a ensuite lavatory. There are 3 bathrooms - one on the ground floor and 2 on the first floor - and 3 separate lavatories. A small passenger lift and stairs serve the first floor. A dining room and sitting room on the ground floor and a combined sitting and dining area on the first floor provide the communal rooms. There is a very small room used as a laundry on the first floor and a kitchen on the ground floor. The home is set in a large plot of ground laid to grass, with a large mature tree, and overlooks a stretch of common land and public right of way across the fields at the rear. A paved patio area with garden seating is accessed from a fire exit door. There is a gravelled parking area for cars at the front of the home. The fee range for this service is currently £518 - £720 per week. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived at the home at 10am and was in the service for 6 hours. The inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the registered manager, Ms Lesley Wright and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires (comment cards) that the Commission had sent out. A total of 8 comment cards were returned: one from a resident; one from a GP who provides medical services to residents; 1 from a health care professional; and 5 from relatives. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. A tour of the building was undertaken. A sample of care plans was examined and this was followed through by meeting the residents to see if the plan matched the care delivered. Lunch was taken with the residents in the dining room. Staff files, and other records required by regulation were examined. Time was spent meeting with the registered manager, residents, and staff. During the afternoon a manager from the new company, Caring Homes, that has bought the home and took over on the 1st June 2007, visited the home and shared in the discussion and feedback at the end of the inspection. The facilities and the layout of the home do not meet many of the current National Minimum Standards for Care Homes for Older People. The home was first registered as a care home in 1988 and, though it met the registration criteria at that time, much of the building is not suitable for more heavily dependent residents. The previous and proprietor acknowledged this and submitted numerous plans to South Oxfordshire District Council, intending to build a new care home on the site of the present home. The first application was made in 1988 and each scheme and/or amendment was rejected. The outcome of previous inspections by the Commission demonstrates that there are aspects of the home’s environment that must be improved or new provision made. Outline planning permission for the most recent application has been granted and Caring Homes are hoping to start work on a new purpose built home, subject to approval of amended plans, in the near future. What the service does well: Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 6 The home is clean and there are no unpleasant odours. Visitors are made to feel most welcome. Residents and relatives’ comments are very positive about the manager and staff, the standard of care, and food. Some of the comments made were: ‘This care home is excellent. Run very well by Lesley, the matron, and all the staff giving a very high standard of care. A very friendly home, good food, excellent care’. ’We are very happy with the matron and staff. They are always pleasant, polite, cheerful and helpful’. ‘Excellent, well-informed matron’. ‘Nursing care is very good. The residents are always clean and dressed well. Food very good’. ‘The care of elderly people appears to be 100 . I think Abbeycrest do a marvellous job …my [relative] never complains to me and she would not be frightened to do so if the occasion arose’. The standard of care plans and records of care given to residents is good, so that staff have clear and detailed written information about the care needed by each resident. The home shows a commitment to making sure all staff have opportunities for training and development so that they provide safe and skilled care to residents. What has improved since the last inspection? What they could do better: Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 7 The inspector saw staff give one resident their medicine added to their food but the reason or consent for this was not written in their care record. The home should ensure that there are the appropriate safeguards, written information, and the consent (if a resident is not able to do so for themselves) of a family member or representative and the multidisciplinary team, on the rare occasion where a resident needs a medication for their own well-being and this has to be given ‘covertly’, for example, added to their food or drink. There has been no further improvement since the last inspection in relation to activities provided for residents – in fact the home no longer has a part-time activities organiser to help residents join in individual and group activities or hobbies. The home manager is hoping that with the appointment of a new activities worker this will help build up a regular and varied programme of activities to improve the social and recreational life of the home for residents. The home should have a formal system of quality assurance that includes asking residents and their families about their opinions of the care and facilities provided. The results of any ‘customer satisfaction’ surveys should be shared with residents and prospective residents. As stated earlier, staff cope well in a building that was not designed for looking after people with physical disabilities and it is understandable that the new proprietors do not want to invest in extensive refurbishment work because they hope to start work on building a new home in the near future. However, there should be continued redecoration work and replacement of damaged or worn items of furniture and carpets because it could be some time before the new building is completed and current residents should continue to have a comfortable and safe environment to live in. The home does not have any sluice facilities to disinfect equipment. The inspector saw some items soaking in disinfectant solution in a toilet that is used by residents. Staff should be careful to safeguard residents and themselves from accidental contact or spillages when using chemical methods to disinfect equipment. 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. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 does not apply because the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are fully assessed prior to admission so that the individual, their family and representatives, and the home can be confident that the placement is appropriate. EVIDENCE: The care records for three residents were examined and showed that a thorough assessment of their individual care needs had been done before they were admitted. The manager or another experienced registered nurse undertakes the pre-admission assessments. Information from other health and social care professionals is included. Relatives’ comments indicated that they were involved in the pre-admission process. The physical layout and facilities of the home are not suitable to accommodate people who have complex nursing care needs, and the manager is careful to ensure that the home accepts only those residents whose care can be safely managed within the existing environment. Abbeycrest Nursing Home DS0000027139.V342167.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good system of care planning in place ensuring that the residents’ physical care needs are met. Overall the medication system is in good order; however, risk assessment and consent should be documented, in situations where a resident is unable to consent to medication considered to be necessary for their wellbeing and where it is agreed that required medication is given covertly in food or drink. Staff have a clear understanding of the issues of privacy and dignity. EVIDENCE: The inspector examined a sample of care plans and followed this through by meeting the individual resident to see if the care delivered matched the care plan. On each occasion there was a clear “picture” of the person, their physical care needs and how these are being met. Care plans are regularly reviewed and updated. The care records also include risk assessments, for example the risk to residents from falls, developing pressure-related skin damage (pressure ulcers/sores) and malnutrition. There was evidence of regular contact and reviews with other health and social care professionals. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 11 Comments received from professionals and residents’ relatives were very positive about the care they receive, for example: ‘Each member of staff considers the individual needs of each resident and looks after them in a very caring manner’. ‘Nursing care is very good’. ‘All the staff give a very high standard of care’ People recognise the difficulties for staff in working in the current building, which limits the space and storage for equipment needed for residents’ care. One person wrote: ‘there will be an improvement with the new facilities but the staff give excellent care in the present conditions imposed on them’. The medication system was examined and found to be in good order. The manager handwrites the Medication Administration Record (MAR) charts for each resident’s prescribed medication and the doctor checks and countersigns the charts. The manager confirmed that since the last inspection the system for the disposal of unwanted or unused medicines has been changed and now meets the requirements and a licensed waste disposal service is employed. The manager has implemented a regular audit of the medication ordering, administration, recording and disposal process. The inspector observed the nurse administering medication to a resident in the dining room at lunchtime. The medication was added to the spoonful of dessert that was being offered to the resident by the care assistant helping them with their meal. The nurse later explained to the inspector that this resident swallowed their medication more easily with their food. However, there was no risk assessment or form of consent/agreement by the resident and/or their representative included in their records for administering medication in this way. This could be seen as hiding or disguising medication that the resident may otherwise not wish to take. There should be documentary evidence that where a resident is receiving medication ‘covertly’ and is unable to give their own consent, the relative’s representative, GP and pharmacist have been consulted and it is agreed that the medication is in the resident’s best interests. The inspector observed staff assisting residents in a courteous and respectful manner, and noted that they always knocked on doors before entering a resident’s room, the toilets or bathroom. The layout of the home and bath and toilet facilities, means that staff have to be particularly careful to protect residents’ dignity and privacy – for example, none of the rooms have en-suite facilities and mobile screens are used where residents in shared rooms are receiving personal care and have to use commodes. Abbeycrest Nursing Home DS0000027139.V342167.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a limited range of activities within the home so that residents do not have a range of opportunities to participate in stimulating and motivating activities. Meals and mealtimes are good and much appreciated by the residents. The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: Since the last inspection, the care assistant who had a dual role as activities worker has left. The manager confirmed that she has interviewed for someone to replace the activities organiser role and was hopeful that the post would soon be filled. There appear to be no planned daily activities for residents, though there have been a number of entertainments and the manager said that care staff do try to play board and card games with those residents who are able to join in. The home has a television and d.v.d /video player in the sitting rooms on both floors. Residents’ rooms were all personalised with their own possessions that they had brought with them to the home. The sample of residents’ care plans examined by the inspector did not record their social or recreational interests in any detail or indicate how care staff could encourage residents to maintain and develop opportunities to join in varied activities that meet their skills and abilities and to what extent the home Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 13 has achieved this. One resident’s review of care stated that the individual would ‘like more activities’ but there was no indication whether this had been addressed. The local church leads a service of “songs of praise” once a month in the home, and a copy of the parish magazine is provided. The Catholic priest also attends the home on a regular basis. Visitors are made welcome and several of the surveys received included comments about Abbeycrest being ‘a very friendly home’; ‘we are very happy with the matron and staff. They are always pleasant, polite, cheerful and helpful’; ‘Abbeycrest is homely’. On the day of the inspection, the inspector spoke to visitors to two residents and they said that they always felt welcomed and ‘at home’ when they visit. The inspector joined the residents for lunch in the dining room. At the last inspection it was recommended that the layout of the dining room should be improved to make access to the dining tables easier for residents using wheelchairs. This has been done and the inspector noted that, although there are still limitations (because of the size of the room and the need for staff to have a clear access route to the adjoining sitting room and for meals service) residents were able to sit comfortably at the tables. The inspector examined the menus, and these showed that there was always a choice of meals available, and that a balanced diet is provided. Snacks and drinks are always readily available should the resident request it. The lunchtime menu was ham with parsley sauce, and a choice of fresh broccoli, carrots and potatoes. Dessert was home made apricot pie, or jam tart, or fresh strawberries served with cream or ice cream. Residents spoken to enjoyed all their meals and said that the cook was very good. The inspector requested sandwiches and the ham and salad filling was very tasty. Written comments also reflected the consistently high standard of meals provided. The staff assisted residents who required help with their meal in a kindly, unhurried, appropriate manner. Staff and residents and a visitor enjoyed conversation over the meal. In common with many NHS and independent care services, the staff represent a much more varied ethnic group than the current residents who are all white British nationals. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Abbeycrest Nursing Home DS0000027139.V342167.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. 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. Residents feel safe and listened to. The home has a satisfactory complaints system with information that is available to residents and their families. The staff are aware of the policies and procedures relating to the safeguarding of vulnerable adults. EVIDENCE: The inspector observed that the complaints procedure is available on the notice board in the entrance hall and in the Service Users Guide. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The manager confirmed that no complaints have been received by the home in the last 12 months. Comment cards from a resident and 5 relatives indicated that they would know how to make a complaint should they need to. The manager is readily available to residents and their visitors and deals with any concerns or ‘grumbles’ promptly. The manager and representative of the new company that has taken over ownership of the home (Caring Homes) confirmed that revised copies of the complaints procedure and information for residents and prospective residents will be made available and copies sent to the commission. The company representative said that residents’ contracts will be revised and everyone will be informed about the company complaints procedure and contact details. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 15 The registered manager told the inspector that all staff receive training in the safeguarding of vulnerable adults as part of their induction and ongoing training. Staff spoken with were aware of the procedures to follow about reporting suspected abuse and their responsibilities under the General Social Care Council code of conduct in relation to ‘whistle-blowing’ about bad practice. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 16 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, 20, 21 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the home’s furnishings and bathroom facilities is poor and considering this, it is commendable that the standard of cleanliness throughout the home is good. The manager and staff do their best in an inadequate environment and maintain a clean and homely environment for residents to live in. EVIDENCE: The inspector toured the building, accompanied by the manager during the morning and then in the afternoon, the manager from the new owner/company accompanied the inspector and discussed the shortfalls of the current building and how these may be addressed in the period before the new proposed building is constructed. As has been reported by regulation inspectors over several years, the standard of the accommodation, facilities and layout of this home fall short of the national minimum standards for care homes for older people. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 17 The ground floor corridor washable floor covering is rucked and coming away from the wall. Numerous pieces of furniture provided by the home in residents’ rooms – wardrobes, chests of drawers, fabric-based divan beds for example, are shabby and in need of replacement. On the first floor landing corridors, an old chest of drawers is used for storing incontinence pads, clinical waste bags and protective clothing for staff, and wardrobes are used for staff uniforms and belongings. The standard of cleanliness was very good in the home. One room had an unpleasant odour despite the efforts of the staff who regularly shampoo the room carpets. The new owners are understandably reluctant to invest in an extensive refurbishment of the existing home because they are optimistic that now planning permission has been granted for a new building, work on the planned new purpose built facility will soon be underway. The company will look to prioritise re-carpeting and redecoration of rooms in the existing home to maintain as pleasant and safe environment as possible. The manager confirmed that several rooms have been re-carpeted and rooms are redecorated as they become vacant since the last inspection. The bathroom facilities are limited, with one ground floor bath with access from only one side, and a fixed bath hoist. The second ground floor bathroom is used as a storeroom because there is insufficient storage space for equipment in the home. On the first floor, a Parker bath is rarely used because access is difficult for staff assisting disabled residents – the door does not open fully because it opens against the bath. There are no shower facilities in the home. All rooms have washbasins. The inspector checked the hot water temperature in the ground floor and Parker bath and in 2 rooms and found it to be within the ‘safe’ range of close to 43°C. The manager confirmed that the requirement made at the last inspection has been met and the maintenance man continues to monitor and record the water temperatures each week. The laundry room is on the first floor and barely large enough to contain the washing machine and drier. The inspector noted that the liquid soap and paper towel dispensers were empty in the laundry room; staff promptly refilled them when this was pointed out. Clean laundry is ironed on the landing area and clean items put into individual named baskets for re-distribution to residents’ rooms. Relatives comment cards indicate that the home manages laundry work well and that residents always look clean and well presented. Outside, the gardens have been improved by the planting of bright summer bedding plants in the borders, hanging baskets and containers, and the grass has been cut, improving the outlook for residents who enjoy sitting out on the patio area at the rear of the home in the better weather. Access to the patio is Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 18 via a narrow fire exit door from the ground floor lounge and there is no external door handle, so residents need to have staff assistance to get in and out. The manager and staff do their best in an environment that is not purpose built for caring for older people with physical disabilities. A relative acknowledged this in their comment card – ‘there will be an improvement with the new facilities but the staff give excellent care in the present conditions imposed on them’. The provider’s representative confirmed that planning permission for the new building has been granted but that further amendments to the plans were still being discussed with the local council planning office. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed at all times to meet the care needs of residents and the recruitment procedure for all staff is robust to ensure the protection of the residents. The registered manager is committed to the training and development of all staff, and training opportunities will be further developed by the new owner/company of the home. EVIDENCE: The staff rosters examined showed that sufficient number and skill mix of staff were on duty at all times, to meet the care needs of the residents. There were 16 residents when the inspection took place. The manager and 4 care staff were on duty during the morning. There was one registered nurse and 3 carers on duty for the afternoon with an additional staff member working a ‘twilight’ shift from 16:30 to 22:00. A cook, kitchen assistant, domestic and laundry worker and maintenance worker were on duty during the morning; and a kitchen assistant for 2 hours in the evenings. The home is staffed overnight with a registered nurse and one care assistant. A sample of staff files was examined and found to be complete and all the necessary pre-employment checks were in place. Discussion with the registered manager and the manager from the new provider company showed a real commitment to all staff having access to appropriate training and development. Caring Homes have their own training Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 20 company and co-ordinator. A training matrix for all staff will be created to show when staff are due to attend mandatory training and updates and training relevant to their work. Staff spoken with confirmed the value of a dementia care training course they had attended, and described the daily exchange of information about care of residents through the handover reports in the home. Seven care assistants have achieved the National Vocational Qualification (NVQ) level 2 in care programme and 4 have NVQ Level 3. The home has met the National Minimum Standard of 50 of care staff being trained. Trained nurses have access to training in order to maintain their registration with the Nursing and Midwifery Council. Relatives’ comments about the staff and the standards of care in the home were mostly very positive, for example: ‘each member of staff considers the individual needs of each resident and looks after them in a very caring manner’; ‘the care of elderly people appears to be 100 ’. However, one person commented that ‘English is not the first language of some carers and the old residents have difficulty understanding them at times’. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 21 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. 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 managed and there is good teamwork with the registered nurses, care, housekeeping and kitchen staff. The processes in place safeguard residents’ financial interests. The home should develop a formal system of assessing its performance that includes seeking the views of residents, relatives and staff. EVIDENCE: The home is well managed by the registered manager who is a registered nurse and has completed the NVQ 4 in Care and the Registered Manager’s Award; she has been in post for 14 years. Comment cards received were particularly complementary about the way in which the home is managed. Comments received included: ‘Excellent, well-informed matron’ (GP); ‘run very well by Lesley, the matron ….I hope with the take over, Lesley can continue to manage the way she has for many years’. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 22 The registered manager does not have a deputy and no allocated supernumerary hours to carry out administrative tasks. However, the former proprietor’s daughter has increased her hours of work as the administrative assistant for the home and this has reduced the administrative burden for the manager; she maintains the accounts and financial records for the business, and deals with invoicing and staff salaries. With the new company takeover, the administrative system and processes are being changed in line with Caring Homes’ policies and procedures. The administrator confirmed that the home no longer handles resident’s personal finances: any small purchases made on behalf of residents is now invoiced and added to their fees. Written records of expenditure for individual residents are kept and residents and their relatives or Power of Attorney are able to view these records on request. There is no formal quality assurance system in place at the present time. However the registered manager does have an “open door” style of management and makes herself accessible both to the residents and their families. Satisfaction surveys have been carried out in the past and the registered manager is planning to develop a quality system in line with the National Minimum Standards and Caring Homes QA systems in the future. There has been good consultation with the residents, families and staff about the new ownership and redevelopment of the home; this is commendable as they work through the change process. A system of formal supervision is in place for all staff and this is recorded and kept on staff files. Records required by regulation were examined and found to be up to date and complete. The home is in the process of adapting all its processes and paperwork to those of Caring Homes, so that this is inevitably a busy time of change and adaptation for all the staff team. As the home does not have a sluice disinfector machine for the effective cleaning and disinfection of commode inserts, advice has been sought from the community infection control nurse as to the most appropriate method to use. All staff have been instructed as to how to clean the inserts and urinals so as to protect the residents from any cross infection. The inspector noted that some commode inserts were left filled with what appeared to be disinfectant solution in an unlocked first floor toilet. The inserts were promptly emptied when this was drawn to staff attention. Staff should ensure that where potentially hazardous chemicals are used to disinfect equipment there are safeguards in place to warn staff and residents that chemicals are in use, and reduce the risk of accidental contact or spillage that could result in injury to residents or staff. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 23 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 3 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 1 2 2 X X X X 2 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 3 X 2 X 3 X X 3 Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 Ensure that there are risk assessments in place and the agreement of resident’s representative (where a resident is unable to give consent) and the multidisciplinary team is documented where necessary medication, required to be given in a resident’s best interest, is administered covertly or added to food and drink. Improve the variety and frequency of activities available to residents to suit the preferences and abilities of residents’ individual social care needs. Residents’ social and recreational care should be included in their care plans and evaluated. Continued to audit the physical environment and ensure that maintenance, redecoration and replacement of worn and/or damaged furniture and soft furnishings continue to be undertaken in the interim period whilst awaiting the completion of the proposed new care home. Implement a formal system of quality assurance that DS0000027139.V342167.R01.S.doc Version 5.2 Page 25 2. OP12 3. OP19 4. OP33 Abbeycrest Nursing Home 5. OP38 includes seeking residents’ views. The outcome of any surveys should be made available to residents, prospective residents and other interested parties, including the commission. Ensure that staff adhere to COSHH and infection control guidance when using chemical disinfection methods for contaminated equipment. Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Abbeycrest Nursing Home DS0000027139.V342167.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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