Inspection on 26/11/07 for Abbeycroft Residential Care Home

This inspection was carried out on 26th 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 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

Abbeycroft Residential Care Home 10/03/09

Abbeycroft Residential Care Home 28/05/08

Abbeycroft Residential Care Home 17/05/07

Abbeycroft Residential Care Home 26/01/07

Abbeycroft Residential Care Home 05/12/05

Abbeycroft Residential Care Home 25/07/05

Abbeycroft Residential Care Home 02/11/04

Abbeycroft Residential Care Home 22/06/04

Abbeycroft Residential Care Home 18/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Abbeycroft Residential Care Home 147 Swift Road Woolston Southampton Hampshire SO19 9ES Lead Inspector Mark Sims Key Unannounced Inspection 26th November 2007 12:30 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 Abbeycroft Residential Care Home DS0000041730.V349838.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. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeycroft Residential Care Home Address 147 Swift Road Woolston Southampton Hampshire SO19 9ES 023 8042 0820 023 8057 94444 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) Abbeycroft Care Limited Vacant Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate two named service users under the age of 65 years. Date of last inspection 17th May 2007 Brief Description of the Service: 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 ¾ 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, separate dining room and a conservatory. 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. The home provides 24 hours staffing. Weekly fees range between £350 and £450. The manager states that a copy of the home’s service user’s guide is provided to all residents or their representatives where applicable. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures the service against core National Minimum Standards. The information used to write this report was gained from the homes Annual Quality Assurance Assessment; a visit to the service and a review of comment cards received from service users, relatives, and health and social care professionals. Other information was gathered from the services history of events, previous inspection reports, direct conversations with staff, analysis of information supplied to and recorded by the link inspector. The fieldwork visit, was conducted over four hours, where in addition to the paperwork that required reviewing we met with service users and spent time discussing their experiences of residing at the home and exploring whether their needs were being meeting. What the service does well: What has improved since the last inspection? What they could do better: Pre-admission assessments were being undertaken and professional assessments obtained where appropriate. However, the in house assessments often lacked detail, with single word responses to questions and the link Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 6 between the assessments obtained or gathered and the care plans produced were often unclear. The care planning and risk assessment process were also poorly structured and maintained, with the plans failing to identify the needs of the service users and therefore how the staff should deliver care or support to meet these needs. The home’s approach to managing people’s medications is also in need of attention, as the home’s controlled drugs cabinet does not conform to best practice guidelines, the controlled drugs register is a loose leaf document, which again does not conform to best practice guidance and individuals medications are not being stored under their specific names within the drugs trolley, as best practice guides, leading to staff storing medications in a haphazard fashion often leading to more than one packet or box of medicines being in use at anyone time. This particular practice makes stock control and rotation very difficult for staff, as people are inclined to pick-up and dispense from the first packet they see, which may not always be the one in use. Activities for service users appeared to be limited to largely self-directed entertainments, watching the television, listening to music, resting on their beds. No programme of activities was seen during the fieldwork visit and the running records and care plans fail to demonstrate what activities or leisure pursuits people have been involved in. The environment was found to be in a very poor stated both decoratively and hygienically. During the fieldwork visit bodily waste was noted on a shower chair, toilet seats and bedding, dirt and debris was noted on the radiators and behind the radiator covers, which was several millimetres thick and high dusting was poor with dirty lampshades, tops of light switches and wardrobes. In the upstairs shower room and total of twenty-one cracked floor and wall tiles was noted, screws protruded from the wall where the broken towel rail had been removed (some of plastic towel rail remained behind the screws), the grab rail within the shower had broken and lifting plastic surround and the metal beneath was rusting. The vanity light in the shower room did not work and the window was not appropriately secured or restricted and so opened fully. A first floor bathroom has no sink and no hand gel dispenser, which could limit the spread of infectious materials, the window is not restricted and opens fully, the room is cramped and poorly decorated and the door opens inwards, which if anyone falls makes entry to the room impossible (there is no environmental risk assessment addressing this issue), the flooring was sticky and unclean and the toilet seat stained. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 7 Within corridors and stairways paper was noted to be peeling off and missing (small patches) and a several hole’s were apparent in the wall. The downstairs bathroom is used to house the home’s cleaning chemicals and these were noted not to be being stored appropriately with some chemical not within a locked cabinet, although after pointing this out to the staff the chemicals were immediately moved and placed within a lockable cupboard. Datasheets were also not available with the chemicals, although the cleaner stated she had seen COSHH datasheets for all of the chemicals in use and believed the file was in the sluice. In another cupboard were toiletries, some were opened and were obviously being used as generic produce with the client’s; people should have their own individual toiletries and washing equipment. The hairdresser’s equipment was stored or left in the bathroom and the curlers used were matted with hair from more than one person, this should be discussed with the hairdresser. Several fire doors or bedroom doors were being held open by means other than an electronic system that would realise the door if the fire alarms sounded. Doors along the main corridor of the home were noted not to have self-closers fitted, which is an issue the provider should explore with the local fire officer. In one room the previous occupant had pulled the doors of their wardrobe and this had been repaired by the maintenance person, the repair consisting of four rough cuts of wood screwed to the outside of the door over the hinges. The laundry and sluice room floor require new flooring as both the water proof floor coverings are ripped or damaged and so no longer provide a barrier against contaminated liquids or fluids getting underneath. One of the small downstairs toilets has a leaking tap or leak generally, which is seeping onto the floor and making it slippery and unsafe for the service users, the staff have tried to contain this by placing a receiver under the leak, however, water was still trickling onto the floor causing a problem. The supervisor stated that the maintenance person was aware of the issue, which had been reported and that it was hoped the problem would be remedied shortly, although no confirmed date for the repair of the leak could be given. The room is also fitted with a shower curtain, which is meant to provide additional privacy when in use, however, this mainly collects bodily waste and is a vehicle for the spread of infection. The emergency cords in the communal bathrooms and toilets were noticed not to extend to the floor, as advised, which would mean any person falling to the floor would be unable to summons help. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 8 Locks are fitted to all bedroom doors, however, these are mortis style locks and not suitable for use with an elderly client group many of whom suffer from memory loss and confusion. In conversation with staff it was established that the only keys to fit the bedroom doors is the master key and therefore if anyone requires or requests a key they cannot have one, unless provided with a copy of the master key, which would provide them with access to all the bedrooms. Carpets in the lounge and corridors were fraying, lifting or rucked up posing a potential trip hazard to service users. 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. Abbeycroft Residential Care Home DS0000041730.V349838.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 Abbeycroft Residential Care Home DS0000041730.V349838.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have the information needed when choosing the home, however the home’s needs assessments are poor and not used effectively. EVIDENCE: Data taken from service user surveys indicates that people were provided with sufficient information prior to moving into the home and that they have a contract of residency. Copies of the residency agreements were seen on the service users plans or files, which were either signed by the client or their representative. The service user plans also contained copies of the assessments carried out by the manager or provided by the clients care manager or social worker. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 11 The in house assessments carried out by the manager contained limited information, which in some sections amounted to one or two word responses to the question posed. The assessments also bore no relation to the care plans produced and so served no discernable use or benefit to the home, the purpose of the assessment to provide information to the management and staff around the care needs of the client and thus help in the development of the persons initial care plans. Abbeycroft Residential Care Home DS0000041730.V349838.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is poorly managed, directed and documented with the care plans and risk assessments produced failing to reflect the care needs of the clients. Medication management is reasonable, although there is significant room for improving the home’s current system. EVIDENCE: The care plans reviewed during the fieldwork visit were poorly maintained and failed to identify or address many of the basic needs of the service users. There was little or no correlation between the information gathered during the assessment process and the care plans production, nor did the plans address the needs of the clients observed and identified by us during the visit, examples being no plans to manage people’s incontinence, no plan to support people’s independence with using urinary bottles, whilst promoting respect and privacy by ensuring doors bedroom doors were closed or the management of Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 13 people’s wish to return to bed for day-time rests and the propensity for faecal smearing, which can result in soiling of their bedding. The home also had no clearly identifiable risk assessment’s, despite records indicating that people are at risks of falls, that clients can be come aggressive and threatening or for environmental risks like the lack of lighting outside where the clients go to smoke and the stair lift, which blocks or obscures part of the stairway and is therefore a trip hazard. The returned Annual Quality Assurance document makes no reference to the home’s care planning process, although it does state that the home’s to promote independence and supports people to undertake tasks like washing and dressing with minimal input. The care plans were being regularly reviewed, however, as they fail to consider many of the client’s needs or problems the review process cannot be considered effective and is largely a paperwork exercise. The service users surveys are generally supportive of the home and the care provided, with the each survey ticked ‘always’ in response to the question ‘do you receive the care and support you need’. However, it would appear from observations that care is largely reactive and not planned or structured. Also the comments of one relative suggest that at time’s people are left to wait for baths or the delivery of personal care due to staffing shortages. The view of a visiting health care professional also raised concerns over the staffs apparent lack of understanding of basic care and the need to ensure that nutritional requirements were addressed and that people received adequate fluid intake, the care plans and assessments failing to assess people’s dietary needs. The home’s ability to support people with their health care needs is a very mixed bag with some aspects of the home’s support good, whilst other aspects is poor. All of the service users feel they are appropriately supported when accessing health or social care services and the observation of the homes care supervisor contacting and speaking with a General Practitioner about the ongoing care and monitoring of a clients health was positive. Contacts with health professionals are document in the client’s records and copies of health care appointments or hospital/clinic visits maintained on the service users file. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 14 However, some service users relatives felt that they were not appropriately or effectively informed of changes in their next-of-kins health and on occasions were mis-informed about doctor’s visits. A visiting health care professional also raised concerns over the lack of staff knowledge when it came to basic age related illnesses and ailments and the lack of consideration for people’s fluid intake and nutritional wellbeing. However, another professional praise the home for the support provided to their client, whose health had improved thanks to the support and routine of the home, which meant he had reduced his dependency on certain medications. Care plans, which are considered as poor, give very little consideration to supporting people with age related health needs, continence issues being one of the main considerations missing from any plans, although psychotic or aggressive tendencies are also ignored. The management of people’s medications are entirely handled by the staff who takeover responsibility for storage, administration and ordering of people’s medicines. The home’s medication storage facilities are adequate, although the controlled drugs cabinet does not comply with current best practice guidance and should therefore be upgraded. Daily medication records were being appropriately completed by the staff, although again the medication records for controlled medicines did not follow current best practice guidance and so must be altered to ensure they are contained within a bound book, with sequentially numbered pages. Medications should also be stored under the client’s name, which enables stock rotation and management or auditing of medications to be appropriately undertaken. On reviewing the home’s medication regime medications were being stored in a haphazard fashion, which was leading to several packets of the same medicine being in use at the same time for the same person. Privacy and dignity, have already been discussed with the home’s care plans failing direct staff towards the basics of closing people’s doors or helping the client adjust to closing their own bedroom door before using urinary bottle’s. Bedroom doors were also noted to be open throughout the majority of the home, some doors held open by artificial means, which would not realise the door in the event of fire and the fire alarms sounding. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 15 Dignity was a concern when touring the premise with large numbers of incontinence products noted to be stacked up in the communal toilets, it would be far better for these products to be secured or stored with cupboards. Shared toiletries do not promote respect for people’s individuality or for their right to have their own hygiene products, which could be kept within their own bedroom and brought to the bathroom when required. Abbeycroft Residential Care Home DS0000041730.V349838.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users are not receiving adequate stimulation or variety in their day and the home’s approach to supporting people maintain their independence is placing them in situations that disregard their dignity and privacy. Residents’ use mealtimes, as social occasions and the new menus offer choice and variety, which the service users enjoy. EVIDENCE: The service user and all but one relative survey indicate that people are generally happy with the level of stimulation or activity provided at the home. During the fieldwork visit no structured or organised activities were going on and the service users were either sat in the lounge watching television or in their bedrooms undertaking self-directed activities. It was noted that a freeview box has been purchased for the service users to watch whilst sat in the lounge, the staff member conducting the tour of the premise stating that the resident’s liked to watch old movies that are screened. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 17 The staff also discussed the music man who visits the home and who seems popular with the service users, however, records to show who attended his sessions or how much the residents enjoyed the event are limited. Recently the home has parted company with its registered manager and whilst a manager from one of Abbeycroft’s sister homes was present during the fieldwork visit, it was difficult to find or locate many of the records required during the inspection. At no time during the tour of the premise or the review of homes records was an activities plan or schedule seen and whilst people seem happy to entertain themselves the overall picture painted is of one where stimulation and entertainment is lacking. Visiting arrangements appear to suite both the service users and their relatives with everyone responding positively to the Commission’s surveys. The home’s ‘service users guide’ sets out for prospective and actual service users the home’s arrangements for visiting, ‘service users will be able to have visitors at any reasonable time, although Abbeycroft has no restrictions on visiting, people are asked to kindly avoid busy times, i.e. lunchtimes’. No visitors were seen during the fieldwork visit, however, the home has a signing in book within the reception, which indicates that a variety of people visit the home and that the times, vary. The service users user’s met during the fieldwork visit also seemed happy with the visiting arrangements and some people have installed telephone’s for the purpose of keeping in contact with family and friends. The service users initially appeared to have a large degree of autonomy and independence over their lives, with people observed taking part in self-directed activities throughout the fieldwork visit. However, upon scrutiny it became evident that the majority of the activities people were concerned with involved them spending time either in bed or sat in their own bedrooms watching television. Whilst this might have been their preference, it was also there only option, as the home provided no alternative form of stimulation or activity, as previously highlighted. The limitation on choice also fell short in respect of the person’s right to have their own personal toiletries and not shared toiletries, which were clearly being used by the staff, as highlighted during the tour of the premise. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 18 People’s independence or their need for support to appropriately manage their independence was also highlighted on arrival at the home, when a male resident was observed using his urinary bottle with his bedroom door wide open. This is not addressed via his care plan, despite this clearly being an issue that he requires assistance with managing. None of the service users self-medicate, despite the home’s ‘service users guide’ advertising this and none of the service users plans contained an assessment to indicate that the residents suitability to manage this aspect of the care had been considered. The service users, as stated, were noted to be mainly in their bedrooms during the visit, which the staff member undertaking the tour of the premise said was not unusual. However, where service users are encouraged to decide for themselves if they retire to bed for a rest, etc any habits or propensity to faecal smearing or incontinence should be considered and the staff directed via the care plans to check people’s rooms on their rising, which clearly was not occurring. Meals were the focus of several relative comment cards with people making comments such as: ‘I feel the food could be better suited to the needs of older people, as it is often small portions of junk food (sausages, burgers, etc.) given at 4 pm and left to suffice until breakfast the next day’. These comments however, were not supported by the views of the service users, whose surveys showed they were happy with the meals provided, although during the fieldwork visit the covering manager and supervisor stated they had updated the menus, as they felt the previous menus had not provided sufficient choice or variety for the resident’s. The new menus that have been drafted do appear to offer both choice and variety of meal and during teatime the service users seemed to enjoy the food provided and the social occasion or opportunities that mealtimes offered. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service are satisfied that they are able to voice their concerns and have access to an effective complaints procedure. However, improvements could be made to the way people are safeguarded from abuse, with an overhaul of the recruitment and selection process required. EVIDENCE: The dataset provided in May 2007, prior to the previous inspection establishes the existence of the home’s complaints and concerns procedure but does not indicate when this was last updated. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: o. No of complaints substantiated: 0. No of complaints partially substantiated: 0. Percentage of complaints responded to within 28 days: 0. No of complaints pending an outcome: 0. On checking with the covering manager and supervisor the home has not received any new complaints since the May 2007 visit. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 20 The general indication, from the service users, their relative’s and the professional surveys is that people are aware of the home’s complaints process and will implement it where necessary. The home makes people aware of its complaints process via its ‘service users guide’, although the document does not contain a copy of the policy, instead informing people of its existence and how to access the information if required. The Dataset establishes that policies for the protection of the service users are in place: ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, however as with the complaints policy no review dates are indicated. There is also a lack of evidence that training around safeguarding adults has been delivered, although the training plan indicates that POVA training has been scheduled before the end of the year. The staff recruitment records also continue to be poorly managed with staff ‘Criminal Records Bureau’ (CRB) checks either requiring updates, as they were last undertaken in 2004 or the CRB not applying to this employment. The home faired little better with its Protection Of Vulnerable Adults (POVA) or basic recruitment checks, files missing POVA clearance or second referees, etc on checking people’s files. In discussion with the supervisor it was apparent that the staff are aware of the home’s protection policies and how to implement them, the supervisor clear that staff are committed to the service users. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment is poorly maintained and decorated and the conditions of the communal and private areas of the home unhygienic and unsafe. EVIDENCE: The feedback from both professional sources raised concerns over the condition of the environment and the poorly maintained and decorated state of the premise. Two relative surveys also raised concerns over the premise, with people making comments like: ‘The place could do with a face lift and redecoration’. During the tour of the premise the environment was found to be in a very poor stated both decoratively and hygienically, with bodily waste noted on a shower chair, toilet seats and bedding, dirt and debris was noted on the radiators and Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 22 behind the radiator covers, which was several millimetres thick and high dusting was poor with dirty lampshades, tops of light switches and wardrobes. In the upstairs shower room and total of twenty-one cracked floor and wall tiles was noted, screws protruded from the wall where the broken towel rail had been removed (some of plastic towel rail remained behind the screws), the grab rail within the shower had broken and lifting plastic surround and the metal beneath was rusting. The vanity light in the shower room did not work and the window was not appropriately secured or restricted and so opened fully. A first floor bathroom has no sink and no hand gel dispenser, which could limit the spread of infectious materials, the window is not restricted and opens fully, the room is cramped and poorly decorated and the door opens inwards, which if anyone falls makes entry to the room impossible (there is no environmental risk assessment addressing this issue), the flooring was sticky and unclean and the toilet seat stained. Within corridors and stairways paper was noted to be peeling off and missing (small patches) and a several hole’s were apparent in the wall. The downstairs bathroom is used to house the home’s cleaning chemicals and these were noted not to be being stored appropriately with some chemical not within a locked cabinet, although after pointing this out to the staff the chemicals were immediately moved and placed within a lockable cupboard. Datasheets were also not available with the chemicals, although the cleaner stated she had seen COSHH datasheets for all of the chemicals in use and believed the file was in the sluice. In another cupboard were toiletries, some were opened and were obviously being used as generic produce with the client’s; people should have their own individual toiletries and washing equipment. The hairdresser’s equipment was stored or left in the bathroom and the curlers used were matted with hair from more than one person, this should be discussed with the hairdresser. Several fire doors or bedroom doors were being held open by means other than an electronic system that would realise the door if the fire alarms sounded. Doors along the main corridor of the home were noted not to have self-closers fitted, which is an issue the provider should explore with the local fire officer, although the covering manager stated the issue was already in hand and new fire doors had been fitted, the self-closure issues should still be clarified. In one room the previous occupant had pulled the doors of their wardrobe and this had been repaired by the maintenance person, the repair consisting of four rough cuts of wood screwed to the outside of the door over the hinges. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 23 The laundry and sluice room floor require new flooring as both the water proof floor coverings are ripped or damaged and so no longer provide a barrier against contaminated liquids or fluids getting underneath. One of the small downstairs toilets has a leaking tap or leak generally, which is seeping onto the floor and making it slippery and unsafe for the service users, the staff have tried to contain this by placing a receiver under the leak, however, water was still trickling onto the floor causing a problem. The supervisor stated that the maintenance person was aware of the issue, which had been reported and that it was hoped the problem would be remedied shortly, although no confirmed date for the repair of the leak could be given. The room is also fitted with a shower curtain, which is meant to provide additional privacy when in use, however, this mainly collects bodily waste and is a vehicle for the spread of infection. The emergency cords in the communal bathrooms and toilets were noticed not to extend to the floor, as advised, which would mean any person falling to the floor would be unable to summons help. Locks are fitted to all bedroom doors, however, these are mortis style locks and not suitable for use with an elderly client group many of whom suffer from memory loss and confusion. In conversation with staff it was established that the only keys to fit the bedroom doors is the master key and therefore if anyone requires or requests a key they cannot have one, unless provided with a copy of the master key, which would provide them with access to all the bedrooms. Carpets in the lounge and corridors were fraying, lifting or rucked up posing a potential trip hazard to service users. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the homes’ recruitment and selection process has been poorly handled, placing the service users at risk of harm. EVIDENCE: The service users surveys indicate that they feel the staff have the skills and experience required to meet their needs and that the staff are generally caring and dedicated individuals. This is a view shared by the service users relatives, who indicated via their surveys that they too found that the staff had the skills and experience required, although one person felt the turnover of staff sometimes left the staff team lacking experience in caring for people with dementia. However, a review of the staff files and in conversation with the covering manager and supervisor it was established that the turnover of staff at the home is reasonably low and that no new staff have commenced employment at the home since the last inspection. When considered against the staffing files, the duty roster indicates that the home has a fairly stable core care staff group and that any turnover occurs in a small transient group of staff. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 25 The home’s duty roster also indicates that staff are deployed in sufficient numbers to meet the needs of the service users. However, as the resident’s needs are poorly identified the staff are inadequately directed towards meeting these basic needs, which undermines the numbers of people on duty. There is also a clear shortage of support staff, i.e. cleaning and maintenance staff, with the premise in a poor state of repair and cleanliness. During the fieldwork visit the home’s domestic staff member was spoken with and asked about the cleanliness of the home. She stated that she had only recently taken up the position, having previously worked as a carer at the home. She also stated that the previous cleaner had left a lot of work for her to catch up on and that she was making inroads into the poor state of the premise. The covering manager also stated that the provider had brought a new carpet shampooer for the home, which would help domestic staff team. However, it is more likely that an increase in the number of cleaners working at the home would ensure the premises was appropriately cleaned in the first instance and then kept clean. A visiting professional raising concerns over the skills and knowledge base of the staff, especially around general ailments suffered by older persons and the importance of a good diet and the promotion of fluids. The Annual Quality Assurance Assessment (AQAA), also suggests that funding for training is limited by the provider, the manager stating that her aim was to: ‘continue to provide training for staff, other than mandatory training, when the owner will supply the funding’. However, the covering manager was to produce a training plan from September 2007 through to December 2007, which included dates for Health and Safety training, Fire Safety training, Protection of Vulnerable Adults and Dementia, amongst other things. The covering manager was also able to demonstrate a new training package that has been brought and introduced into the home by the provider, which consists of both a training programme and a training matrix for documenting the training completed by staff. The dataset indicates that only 33 of the care staff employed at the home currently possesses a National Vocational Qualification (NVQ) at level 2 or above, although a further six staff were said to be working towards their certificates. Despite a reduction in the size of the staff team from fifteen people according to the AQAA, to twelve on the duty roster, since the last inspection the Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 26 covering manager and supervisor provided data that indicates the home still has 33 of its staff trained to NVQ 2 or above. A review of the staff employment files established that no improvement have been made in the recruitment and selection process, with the last inspection finding that staff were being employed without appropriate CRB and POVA checks in place. At this visit seven staff files were scrutinised and found either to contain CRB’s taken up in 2004 and therefore in need of updating, in accordance with current best practice guidance or the applicant or employee had no CRB for the current employer. Several files were also found to contain only a single reference and in one case no references at all, the recruitment and selection process clearly placing the service users at risk, as the employees have not been appropriately vetted. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management and administration of this service is poor and does not embrace the values of openness and respect. There is no effective quality assurance system and the home does not have a qualified or competent manager in post. EVIDENCE: The home does not presently have a registered manager, as the previous manager resigned following problems at the home. The extent of the problems experienced are unclear, however, a letter sent to the Commission by the outgoing manager, dated 21st September 2007, suggests she was not being appropriately supported by the provider. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 28 This accusation was also repeated within Annual Quality Assurance Assessment where, as quoted earlier, the manager felt that staff training could not be effectively planned or delivered until the provider was prepared to release funding. The condition of the home, environmentally, also suggests that the provider is reluctant to properly invest in the service, which again adds weight to the previous managers’ concerns about lack of support and funding. Comments provided via the professional surveys also pick up on the lack of support provided to the previous manager by the provider: ‘the owner seems very distant and unappreciative of the commitment of his staff to the residents’. This is poor management in my view. There was also a lack of regulation 26 visit reports, which indicate that the provider was failing to monitor the conduct of his previous manager and therefore the service being delivered to the residents’. Regulation 26 makes it clear for providers’ that they must visit their services monthly or arrange for them to be visited and a report produced, copies of these reports must be made available onsite for the purposes of inspection. The provider’s apparent lack of involvement in the service and support for the manager, as demonstrated by the poor condition of the environment, the managers comments and the views expressed via the professional and relative surveys all add to the evidence that the provider is failing to ensure the appropriate and satisfactory running of the home. The previous manager had introduced a more formalised quality assurance programme prior to resigning her position, with questionnaires and comment cards made available to visitors, a selection of questionnaires noticed on display within the entrance hallway. The Annual Quality Assurance Assessment also makes reference to resident’s meetings, which the last inspection confirmed were occurring regularly and were being minuted. The covering manager did state that management meetings are arranged and that Abbeycroft’s previous manager did attend these meetings, which offered peer support and the opportunity for people to discuss problems or ideas. In house staff meetings have become less frequent since the manager resigned, although the supervisor has tried to keep these events going and the staff informed of issues affecting the home. It is the policy and practice of the home not to become involved in the management or administration of residents’ finances other than to provide a Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 29 facility to safeguard monies or valuable on request. The home’s service user’s guide makes reference to the policy. Health and safety is a major concern, with the tour of the premise identifying a number of health and safety considerations, as highlighted within the environment section of this report, including: Chemicals not being stored in accordance with the ‘Control of Substances Hazardous to Health’, (COSHH) regulations. No COSHH data-sheet information available with the chemicals in day-to-day use. Windows on the first floor that are not fitted with appropriate restrictors. Leaking taps or connection on sinks that enable water to reach the floor making it slippery and a potential hazard. Frayed, poor laid or stretched carpets in communal areas of the home, which pose potential trip hazards. Poor attention to hygiene and cleanliness, which could lead to the crosscontamination of bodily waste and the spread of infectious materials. Fire doors that were being held open by devices or items that will not realise automatically should the fire alarms sound. The home approach to risk assessment and the identification of potential risks is poor, with no environmental risk assessments for the stair lift and the people using the stairs, the toilet door that opens inwards and the potential for people to become trapped behind the door or the client’s who smoke and go out onto a poorly lit decked area. The home’s approach to individual risk assessments were also poor with no identification or assessment of people’s propensity for falling, aggression or incontinence, which can lead to excoriation and irritation of the skin. Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 30 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The manager must ensure that the needs of the service users are properly identified during the assessment process and that people’s needs are kept under regular review, with changes in their assessed needs reflected through the care planning process. The manager must ensure that the service users plans address all of the assessed or identifiable needs of the service users and that any changes in their circumstances are reflected within the care plans. The manager must ensure that unnecessary risks to the health and safety of the service users are identified and that appropriate plans are produced to reduce or eliminate the potential for harm. The manager must ensure that the staff have the skills and knowledge required to support service users with their health related problems. Timescale for action 20/01/08 2. OP7 15 20/01/08 3. OP7 13 20/01/08 4. OP8 13 20/01/08 Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 32 5. OP9 13 Records must reflect any changes in the person’s health status and arrangements for contacting any and all next-ofkin must be documented. The manager must ensure that medications are properly stored or held as this ensures appropriate stock rotation and improves the monitoring medication stocks. The records for the administration of controlled drugs within the home must be improved, with an appropriate register provided for the purposes of documenting when controlled substances are in use. The manager must take steps to ensure that privacy and dignity issues are identified within the care plans and that staff are educated on how to support and promote these values. Practices within the home that undermine the promotion of dignity and privacy must be tackled and eradicated. The manager must review the homes’ approach to supporting people with their social care needs, which must include details of their preferred hobbies or leisure activities. The homes’ programme of activities must then be reviewed and updated and people regularly consulted on the values and benefit of the social stimulation provided. The manager must take steps to ensure that where people can make choices around the care they require this is appropriately identified, planned and delivered DS0000041730.V349838.R01.S.doc 20/01/08 6. OP10 12 20/02/08 7. OP12 12 20/01/08 8. OP14 12 20/01/08 Abbeycroft Residential Care Home Version 5.2 Page 33 by the staff team. The support provided by staff must be considerate of the persons’ wishes and respectful of the impact the service users request or need might have on other residents’. The manager must take steps to improve the home’s approach to the recruitment and selection of new staff, with all appropriate checks undertaken prior to the commencement of the new employee. 9. OP18 OP29 13 & 19 20/12/07 10. OP19 23 This requirement remains outstanding from the last two inspections. The manager must take action to 20/01/08 address the environmental issues identified during the fieldwork visit. The manager must also device a quality auditing system, aimed at monitoring the decorative and remedial condition of the premise and produce plans to address maintenance issues. The manager must undertake a review of the home’s domestic staffing arrangements and provide appropriate staff numbers and hours to ensure the home is clean and free from possible sources of crosscontamination. The manager must take steps to ensure that a minimum of 50 of the care staff are trained to National Vocational Qualification level 2 or equivalent. The provider must ensure that a competent and qualified manager is appointed to the position and that they are appropriately supported and DS0000041730.V349838.R01.S.doc 11. OP26 13 20/01/08 12. OP30 18 20/04/08 13 OP31 10 20/02/08 Abbeycroft Residential Care Home Version 5.2 Page 34 14 OP33 24 26 monitored, thus ensuring the satisfactory operation of the home and the safety and wellbeing of the service users. The manager and provider must 20/01/08 establish and implement systems for monitoring the quality of the service provided to the service users, which includes reviewing care and support, records and documents and environmental conditions. The provider must also ensure that regulation 26 visits are undertaken and more importantly that they are become an effective process for monitoring the operation of the home. The manager must ensure that risk assessments are undertaken for both the individuals living within the environment and environmentally. The manager must ensure that health and safety legislation is complied with, COSHH datasheets, cross-contamination for example, should he/she be unaware of how to address or manage these issues he/she must contact the Local Authority Environmental Health Dept for advice and Guidance. 15 OP38 13 20/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 35 1. OP7 People who use the service and staff would benefit from additional information being recorded on the care plans and risk assessments to ensure consistency of care and better evidence the quality of care provided. Upgrading the current controlled drugs cabinet would improve the arrangements for safe storage of medicines. 2. OP9 Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Abbeycroft Residential Care Home DS0000041730.V349838.R01.S.doc Version 5.2 Page 37 - 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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