Random inspection report
Care homes for older people
Name: Address: Abbeycroft Residential Care Home 147 Swift Road Woolston Southampton Hampshire SO19 9ES one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gina Pickering Date: 1 0 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Abbeycroft Residential Care Home 147 Swift Road Woolston Southampton Hampshire SO19 9ES 02380420820 023805794444 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Abbeycroft Care Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 0 0 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home Abbeycroft is a home providing care and accommodation for up to 20 older people with age related mental health problems and illness associated with dementia. It is one of a number of homes in the Abbeycroft Care Ltd group. The home is situated in Swift Road Woolston about a 3/4 mile from the local shops and about the same distance from Weston Shore. All but one of the rooms are for single occupancy and arranged over two floors. Access to the first floor is via a stair lift. Communal areas consist of a lounge and a separate dining room . There is a toilet and shower facility on the first floor, and two bathrooms and several toilets on the ground floor. There is a driveway and car park to the front, from which there is level access into the home via the front door. The home is surrounded by gardens with seating areas, accessible to residents via ramps. Care Homes for Older People Page 3 of 13 What we found:
This random inspection was carried out to assess the services compliance with requirements made following the previous key inspection on 28 May 2009. We had also been informed by Social Services about safeguarding concerns they had about poor care provision for people living at the home. because of these concerns Social Services had been closely monitoring the care provision at Abbeycroft Residential Home and had been providing support to the manager to help improve the provision of care at the home. We were told by Social Services that care plans did not fully detail peoples needs and the actions to be taken by staff to meet their needs. We had a look at six care plans for people living at the home. Details about peoples medical conditions were listed on the front sheet of the care plans, though in one persons file it was not clear that the detail was an actual clinical diagnosis or what the diagnosis actually meant. This indicated that staff did not have a full understanding of the persons mental health diagnosis,which could in turn result in this person not having their mental health needs fully met. We discussed this with the manager who told us she would discuss the diagnosis with the Community Psychiatric Nurse to ensure the persons diagnosis was correct and staff understood the diagnosis. Social Services had told us they had concerns that staff and the manager did not have a good understanding about the Mental Capacity Act and how it affected the provision of care for people living at the home. The manager has responded to these concerns by liaising with the Community Psychiatric Nurse. The manager told us the Community Psychiatric Nurse is going to advise about the mental health needs of people living at the home and to assist her with the assessment of mental capacity of people living at the home. Care plans included assessments of the persons needs that included personal cleansing and dressing, eating and drinking, breathing, mobility, sleeping, communication, vision, elimination, mouth care, feet care, skin care and integrity. Risk assessments were in place for falls and moving and handling. For people who had needs relating to diet this was included in the care plan documents. For example for people who had diabetes there were details about their dietary restrictions and how their condition should be monitored. We saw evidence that these people were having relevant monitoring of their condition by staff at the home. Staff that we spoke with were aware of dietary restrictions that people living at the home had. Detail of the assistance people needed to meet their personal care and dressing needs were recorded, though greater detail was needed in some instances. The manager told us that she is in the process of developing detailed descriptions of each persons daily routines that will include details about the assistance they need and wish for in meeting their personal hygiene and dressing needs. We saw a completed description of one persons daily routines that gave good details of the assistance needed and what the person could do for themselves. This person needed washing and dressing as they could not do it themselves, but likes to chose their own clothes. The manager has developed personal care records that are maintained in the bathroom that include greater detail about the assistance a person needs in maintaining personal hygiene. Social services had raised concerns about the recording of baths that people had had. We noted that the record of baths in care plan documents was very sparse, these records could not evidence that people living at the home were having the opportunity to take baths on a
Care Homes for Older People Page 4 of 13 regular occurrence. We discussed this with the manager. The recently introduced personal care records that are kept in the bathroom are now being used to record when people have baths or showers. We looked at a sample of these records. Each person living at the home has a tray in which their individual toiletries are kept, details of the assistance they need along with any moving and handling issues and records of baths, hair washes and showers are detailed. All this is kept in a locked cupboard in the bathroom which means people living at the home do not have access to other peoples toiletries and the risk of them ingesting toiletries is minimised. This again has been implemented following the close monitoring of the service by Social Services. Social services told us they had concerns about the standard of care people living at the home were receiving to prevent the formation of pressure ulcers. We had been informed by social services that the community nursing and occupation therapy teams had been involved in supporting staff and people living at the home resulting in pressure relieving equipment being provided. Care planning documents detailed the use of such equipment including special mattresses and cushions as well as the involvement of district nursing services to advise on the management of skin integrity for people assessed as at risk of developing pressure ulcers. We observed pressure relieving equipment in use. Care plan documents that we looked at had assessments of peoples risk of developing pressure ulcers. However the information we received from Social Services and details in care planning documents indicated that the involvement of district nurses and provision of pressure relieving equipment had primarily occurred as a result of Social Services monitoring of the care provision at the home. Care plans had details of how staff should support people with mobilising. This included updated information provided by relevant health care specialists to reduce the risks of people harming themselves whilst mobilising. Social services had also raised concerns about the frequency of weighing people and the accuracy of those weights. The scales at the home had not been suitable for people with mobility problems to stand on. We noted that people living at the home had weights recorded but that the scales were still unsuitable for all people to be weighed on. The manager told us that a new pair of scales was on order and were due to arrive later that week after which all people would be weighed again to ensure accuracy of weights recorded. We had conversations with several people living at the home, none of which expressed any concerns with the care and support they were receiving. Some people were able to tell us clearly what help they needed and told us that staff give them the support and care they need in the way they wish. One person told us that he/she had heard about a care plan but did not know the details in it. However he/she told us he/she needed very little help and staff were always around to give him/her help when needed. This person told us that he/she could not remember having had any contact with health care professionals since moving to the home, but records evidenced that he/she had had contact with health care professional such as GPs. We observed staff considering the views of people with regard to their care. One person was uncomfortable sitting on new pressure relieving cushion. Staff discussed it with the person, took it away and made a note in that persons file that this must be discussed with the district nurse to ensure adequate pressure relieving care is provided. One person told us that they were unable to walk and staff moved him/her around the home in a
Care Homes for Older People Page 5 of 13 wheelchair. We observed this person being transferred from a sitting chair to wheelchair in a safe manner. We looked at medication practices at the home. At present nobody living at the home manages their own medications. The manager told us she had provided all people with a locked cabinet to store medications in if they were assessed able to manage their own medications and if they wanted to do so. As we looked round the home we noted that lockable cabinets in peoples bedroom looked new. Medications are stored in locked cabinets with the medications presently in use locked in a medication trolley that is secured to the wall. We observed staff administering medications following the correct procedure, only signing for the medications once the person had taken them. Medication Administration Record (MAR) charts that we looked at indicated that all medications administered are signed for. A rigorous medication audit system that has been introduced by the new manager ensures there are no medications missing and there no discrepancies on the MAR charts. Staff confirmed that as part of the medication ordering process prescriptions are seen for each person living at the home. This ensures that people receive the medications that are prescribed for them by their medical practitioners. However it was noted that there was a lack of guidance for the use of some as required medications. Guidelines were in place for medications to relieve pain, but for other medications such as those to relieve constipation there were no guidelines. This meant it could not be assured that people were receiving as required medications when needed and did not receive them if they were not needed. Because of the concerns raised by social services about the quality of care provision at the home we looked at the training for staff members. The manager shared with us the training matrix that detailed training staff members had completed and identified training that was required. It was evidenced that all staff have completed training in moving and handling, health and safety involving the Control of Substances Hazardous to Health, fire safety and for people recently appointed there was a programme of ongoing induction. However it was evidenced that areas of training had not been kept up to date for staff working at the home. This included training about first aid, food hygiene and mental capacity. This training was now being arranged. All but three members of the staff team had received training about safeguarding vulnerable people. Discussion with staff members indicated they had an understanding about safeguarding people and would take the correct procedures if they thought abusive practice was occurring. As part of the monitoring of the home social services had observed areas of the environment that posed risks of injury and cross infection to people living at the home. As part of our inspection we looked at various areas of the home including bathrooms, communal areas, bedrooms, and the kitchen. It was noted that some work had been done to address issues that had been raised by Social Services including removing trip hazards, cleaning equipment and covering electrical wiring with trunking. However there are still several areas of the environment that have the potential to cause harm to people living at the home. We noted that the tiling around many sinks in bathrooms and bedrooms was chipped and cracked with dirty looking grouting. This would make it difficult to thoroughly clean round the sink areas thus increasing risks of cross infection. Furnishings in some bedrooms was tatty with veneer peeling off furniture. Some ceilings had flaking paint and plaster. Cord pulls in bathrooms needed replacing as they were dirty. Carpets in some areas looked in need of replacing, being worn and stained. We were told by the manager that the dining room carpet was being replaced with carpet that would be easier to clean. Despite some areas of carpets being worn there were no
Care Homes for Older People Page 6 of 13 trip hazards identified because of this. Social Services had told us that there had been a lack of essentials such as toilet paper on some bathrooms. This was not observed to be the case during our visit. When we arrived at the home the manager was checking all areas of the environment of the home. She told us that she completes a daily check of the environment that is documented and any immediate concerns are addressed. We saw documentary evidence of this occurring. She also told us she has commenced a fortnightly full audit of the environment that includes health safety and maintenance issues that is being documented and acted on. This means that action has been taken to comply with a requirement made following the previous key inspection that a system for identifying and rectifying potential health and safety hazards in the home must be implemented. We noted that in some bedrooms there were stand alone electric heaters. Care plans identified the reason for this was because the heating in some areas of the home was not working and detailed the safe management of the heaters to reduce risks to people living at the home. All areas of the home were warm on the day of our visit. During our visit to the home we tested the water being distributed from hot water taps with our hands. For some areas this extremely hot to the touch. We informed the manager of our findings who immediately asked the maintenance team to remedy this problem. We also noted that for a period of about 5 minutes the kitchen was left unattended with boiling pans of food cooking on the stove. The kitchen is accessible to people living at the home. The action of leaving the kitchen unattended meant there was a risk to people harming themselves with hot food or equipment in the kitchen. This concern was discussed with the manager who told us she would address this issue with staff members to ensure it did not occur again. At the previous inspection a requirement was made that adequate cleaning schedules are put in place to ensure the home remains clean at all times. During our visit we noted that a member of staff was on duty for the sole purpose of cleaning the home. All areas that we looked at were clean and tidy. The cleaner confirmed she has sufficient time and equipment to clean the home. The implementation of daily and fortnightly audits of the environment will enhance the monitoring of the cleanliness of the home. The home has complied with this requirement. At the last inspection a requirement was made that the provider must ensure that the he makes regular monthly visits to the home and these thorough enough for him to satisfy himself about the quality of the service and must keep records of all such visits. We saw such reports for visits made in November and December 2009 that provided sufficient information to make decisions about the quality of service provided at the home and what improvements were required. However it must be noted that concerns about the management of care provision at the home had not previously been identified in these reports. The manager told us a visit had been made in January and she was waiting for the written report to be provided. At the previous inspection in May 2009 there had been a manager in post for over a year who had recently submitted an application to us for registration as manager. Since that inspection this person was registered as manager and has since resigned from her position and left employment at the home. A new manager has been appointed who is aware of the need to submit an application to us for registration as manager. Discussion with staff members indicated they believe the service is improving under the leadership
Care Homes for Older People Page 7 of 13 of the new manager. They told us the home is cleaner and more structured now with staff working together more as a team. However they indicated in conversations that there are still improvements to be made with regard to staff working as a team. The manager told us she has held staff meetings and has been meeting with staff in supervision sessions to ensure everybody has the same common goals to improve outcomes for people living at the home. We spoke to the manager about the support she receives from the registered provider. One of the senior managers in the organisation provides support to the manager. We had a conversation with this person who told us that the problems with the management and the care provision at the home was as a result of the poor management of the previous registered manager. It is concerning that the audit systems of the registered provider that include monthly visits and reports did not identify the problem. The senior manager acknowledged to us that she had reduced the level of supervision and support to the previous manager once she was registered with CQC which she now feels was a mistake. What the care home does well: What they could do better:
There needs to be detailed guidance for the use of all as required medications for each person living at the home. This will ensure that people will only receive these medications when they need them. The decor and furnishings in some areas of the home need attending to to ensure people are living in a pleasant and homely environment and there are no risks of cross infection. The manager has identified areas of training that are required by staff members. Staff members must receive this training to ensure they have they have the relevant skills and knowledge to provide the care and support that people living at the home need. It must be ensured that people living at the home are not exposed to unavoidable risks associated with them entering the kitchen. The service needs to be able to identify where changes need to be made to improve outcomes for people living at the home and not make changes only as a reaction to assessments from other organisations such as Social Services and CQC. Changes being made in the running of the home must be sustained and embedded into care practice to
Care Homes for Older People Page 8 of 13 ensure the wellbeing of people is always protected. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Guidelines must be in place for the administration of as required medications for each person living at the home. So people only take as required medications when they are needed. 01/04/2010 2 19 23 The furnishings and decor of 09/04/2010 the home must be made good. So people live in a pleasant and homely environment. 3 30 18 Staff members must receive training to equip them with the skills an knowledge to meet the needs of people living at the home So people living at the home are supported and cared for by staff members who have the relevant skills and knowledge. 07/05/2010 4 38 13 Water being distributed from 25/03/2010 taps must be of a safe
Page 11 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action temperature. So people living at the home are placed at risk of scalding themselves. 5 38 13 Tiling around sink areas must 09/04/2010 be made good. So risks of cross infection and harm to people living at the home are minimalised. 6 38 13 Staff must not leave the 25/03/2010 kitchen unattended and accessible to people living at the home. So people living at the home are not exposed to risk of injuring themselves in the kitchen. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
