Inspection on 20/05/08 for Abbeydale

This inspection was carried out on 20th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeydale 23/10/08

Abbeydale 19/12/07

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Brook Drive, 124

Rugby House Project

City Roads Crisis Intervention

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Abbeydale 98 Bisterne Avenue Walthamstow London E17 3QS Lead Inspector Sarah Buckle Unannounced Inspection 20th May 2008 08:45 Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 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 Abbeydale DS0000069950.V364342.R02.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 Adults 18-65. 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. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeydale Address 98 Bisterne Avenue Walthamstow London E17 3QS 020 8509 4100 020 8509 4101 pchibagu@schealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Active Care Partnerships Limited Post vacant Care Home 12 Category(ies) of Past or present alcohol dependence (12), Past or registration, with number present drug dependence (12), Mental disorder, of places excluding learning disability or dementia (12) Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Past or present drug dependence - Code D 2. Past or present alcohol dependence - Code A The maximum number of service users who can be accommodated is: 12 19th December 2007 Date of last inspection Brief Description of the Service: Abbeydale Care Centre is part of Abbeydale Independent Hospital. There are four units within the hospital and Abbeydale is the only one to be registered with the Commission for Social Care Inspection as a care home. The home is registered to accommodate twelve people with past or present mental disorder, drug and alcohol dependence. At the current time there are five residents living at the home and the funding authorities for these residents are North East London Mental Health Team, Plymouth PCT, Redbridge PCT and Barking and Dagenham Borough Council. The home is situated in a purpose built building and is near to Walthamstow town centre with all of the amenities that this offers. There are bus routes near to the home. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 0 Star. This means the people using this service experience poor quality outcomes. This was a routine unannounced key inspection carried out by two inspectors. The inspection included a visit to the service, which lasted seven hours. This equates to fourteen inspection hours. During this time a tour of the premises was completed, relevant documents and records examined, staff members, residents and members of the management team spoken with. This service is of such concern that enforcement action is being considered. The general manager of the Abbeydale Independent Hospital completed the Annual Quality Assurance Assessment (AQAA) in the absence of a registered manager at the Abbeydale Care Centre. This was a well-completed and informative document. A number of surveys were forwarded to be distributed among residents, staff, relatives and health care professionals. However, only three of these, which had been completed by residents, were returned to the Commission. Unfortunately, the residents had completed forms that were meant to gain the views of relatives, carers or advocates, so some of the information contained within them is not clear. Copies of a training matrix and staff rotas were requested during the inspection, on a number of occasions; however, these were not made available during the course of the day. A telephone call to the newly appointed manager of the service confirmed that these had been posted on 05/06/08, sixteen days after the site visit to the home, however on 10/06/08 they still had not been received. It was of concern to note that the management team at Abbeydale Care Centre did not have appropriately qualified staff on duty at night, and this placed the residents at risk of potential harm. It was also concerning that the staffing and medications management within the home indicated that the overall management arrangements at Abbeydale are not sufficiently robust to protect the well-being of residents. Feedback was given to the general manager at the end of the site visit. What the service does well: Abbeydale enables the people who live within the home to access the immediate community. The healthcare needs of residents are in the main part well managed. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 6 There was recorded evidence of some rehabilitative work, whereby a resident who tended to eat alone was supported to eat with the other residents. One resident survey stated in the ‘what do you think the care home does well?’ section “I think the care home does well”. What has improved since the last inspection? What they could do better: Abbeydale Care Centre is a unit within a purpose built independent hospital. The culture and expectations of a hospital are very different to those of a care home. At the last key inspection, the care home felt like part of the hospital. Although this has improved somewhat, there is still a long way to go for the staff members and management team at Abbeydale to make clear the differences and to ensure that the care home stands alone and is not influenced by the practice and ethos of the hospital. The care home unit is ‘the home’ of the people that live there. At the moment it does not feel like their home. Initial assessments examined were completed after admission as opposed to prior to admission and there was no Care Programme Approach information and no information from the care management team. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 7 People who live at Abbeydale do not have enough active involvement in the day-to-day running of the home and some of the routines outlined within care plans were prescriptive. There are limited activities arranged for the people who live at the home. Even where clear needs are identified i.e. the wish of a resident to do a course in art or poster design, these are not implemented. One resident stated in the ‘How do you think the care home can improve?’ section of a survey “I think the care home can still improve and organise more trips”. The overall environment within the home still has an institutional feel to it that would be improved by making the home more comfortable and homely. Medication practice at the home does not operate with consistently best practice. Training of staff is due to be implemented but is not currently satisfactory, particularly in staff understanding of complaints, and action should be taken to remedy shortfalls in staff practice. Staff rosters are inadequate, staff work long days, do not have a set rota, and it is only possible to see all staff rostered on a weekly basis. In addition staff full names and designations are not included on the rota. The general manager for the entire hospital has also been managing the care home. There is the potential for conflict within this as the culture difference between hospital wards and care homes is significant. 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. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are admitted to the home without a clear assessment being completed prior to this, to determine whether their needs can be met. EVIDENCE: The General Manager of Abbeydale Hospital stated that there had been three residents admitted to Abbeydale care home since the last key inspection. He also stated that two of the people who had lived at the home had moved on owing to deteriorating mental health issues and as the home was unable to meet their needs. Two care plans were examined during the key inspection regarding initial assessment. One of these was examined in depth. This file had a clear service user profile, which outlined the residents name, date of birth, next of kin etc. It also contained a ‘social profile’ and admission information, including a brief medical history. Further assessment documentation was contained within the file, which was focused on the persons mental health and included ‘general information regarding what’s going on in the residents life’ and questions about whether Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 10 the resident was sleeping ok, had low energy, had lost their enjoyment. The assessment did not outline what support the resident would need to manage their identified needs i.e. One section was concerned with whether the resident felt guilt and whether this was rational or irrational. The assessment stated, “After swearing (at) staff, (the resident) normally feels guilty and apologises. This is rational”. Areas such as attempts at self-harm, harm to others, psychosis, cognitive function etc are also assessed. The assessment stated that there was no risk of self harm or of harm to others, however, this was contrary to the admission information received regarding this person, which stated “…Risks of aggression towards others, absconsion, self-harm and self-neglect”. A ‘risk assessment screening’ document was also completed as part of the initial assessment process, and a risk management plan drawn up to show how these risks would be managed. The risks identified for this resident included aggression towards staff, anti social behaviour, self-neglect and relapse in mental state. Absconsion and self-harm were not identified as risks when these had been previously. This was of concern as the resident does leave the care home and access the local community unsupported and there was no documentation in seen to show how this was being managed. The initial assessment process also contained new documents such as a dependency tool which had been completed on admission and on 13/05/08 and a nutritional risk assessment which was completed on 13/05/08, resulting in a score of (8) meaning that there was ‘cause for concern’. There was no management plan in place in relation to this. There was no reference to integrating information from the resident’s Care Programme Approach and there was no information regarding this contained within the assessment. The assessment information contained on the file had been completed at the point of, or after admission to the home. The resident concerned had been admitted from the Abbeydale Independent Hospital, however, as this is registered separately from the care home, it is important that the Care Homes Regulations are complied with. A requirement has not been made on this occasion as enforcement action is being considered. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Abbeydale Care Centre recognises the rights of individuals to take control of their lives and make their own decisions, however this does not always happen in practice. Each person has a care plan and these are becoming person centred, however, the care plan does not consistently reflect the care being given. EVIDENCE: Three care plans were examined during the course of the site visit to this service, two of these by one inspector and one by a second inspector. It was positive to note that there was improvement in the care planning process, with more detail being contained in individual care plans. For example, one resident had a care plan in place regarding ‘Aggressive Behaviour’, completed on 18/05/08, and this said things such as, “Encourage (the resident) to vent pent up emotions through discussion with staff during Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 12 1:1 sessions” and “Assist the resident to build therapeutic relationships based on trust, empathy and respect with staff”. The care plan also stated that incidents of aggression should be monitored and note the triggering factors, however, no evidence was seen of these records being kept. However, there were some instances where the care plans were not specific enough, for example the care plan regarding ‘Relapse’ stated “…encourage dialogue and offer guidance and encouragement” and “encourage reality based thinking”, but did not detail how the staff team would manage this. It was positive to note that a care plan had been devised specifically in relation to ‘Potential loss of sexuality and potential negative impact on self-esteem’, which stated its aim as “To promote freedom in expressing (the resident’s) sexual needs” and which outlined support such as “Discuss with (the resident) any sexual needs in a non-threatening supportive environment”. The care plans examined had been devised using some of the information contained within the initial assessment; however, the information within the plans was not fully put into practice within the home. For example for one resident there were a number of references regarding using a befriending service as a means of preventing their isolative behaviour, i.e. “ Involve befriending services to develop and facilitate enjoyable social interaction” however, even though the resident had been living at the home since December 2007, there was no evidence that this action had been taken. There was also reference to the resident wanting to undertake art and poster design classes, as well as expressing an interest in pottery, cookery and carpentry but there was no evidence to suggest that action had been taken to meet these identified needs of the person living at the home. The care plan contained a prescriptive document based on a ‘meaningful day’ for the resident. This detailed how the days of the week would be spent by the person living at the home, for example, on Mondays between 08.30 and 10.30 the document states ‘personal hygiene (breakfast and meds)’; between 10.30 and 12.00 ‘room cleaning’; 12.00 and 13.00 is ‘lunch/siesta’; 13.00 to 17.00 is ‘shopping’; 17.00 to 18.00 is ‘dinner/ relaxation’ and 18.00 to 22.00 is music/TV and meds’. This document does not demonstrate that the resident has choice during the course of each day to do as they wish depending on how they are feeling. The meaningful day chart for Wednesday stated that in the morning between 10.30 and 12.00 the person would go swimming. There was no evidence contained within the care plan or the daily care notes to suggest that this happens. The resident’s daily care notes were examined and it was positive to note that they were receiving support from the staff team to sort out their financial situation. One resident survey received by the Commission did state that the home was good at helping them to get their benefits and freedom pass. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 13 During the course of the inspection one resident spoken with stated that they had not had a key to their bedroom and that they had returned to their room to find a male resident in it. They stated that they repeatedly asked for a key and that it took a significant period of time for one to be provided. Similarly, Abbeydale Care Centre now has its own front door, however, this is locked and residents do not yet have keys to access it for themselves. In the daily care notes for one resident it states that on 15/05/08 the resident ‘…got up at 6.30 and asked staff to open the main door as (they) wanted to go out for a morning walk’. During the course of the inspection the front door was tried and was locked. The general manager of the hospital also stated during feedback, that residents have to ask a member of staff to open the front door for them. The communal bathroom is also locked and residents have to request that a staff member open the door for them if they wish to access it. No reason for the door being locked was given, however, residents do have an en-suite with toilet and shower facilities. A requirement has not been made on this occasion as enforcement action is being considered. Risk assessments were completed and contained within the individuals care plan. For one resident there were risk assessments in place for smoking, physically and verbally aggressive behaviour, relapse, abuse, anti-social behaviour, self-neglect and isolation. There were no risk assessments in place regarding absconsion or self-harm, when these had been identified as risks during the initial assessment. The risk assessments that were completed were detailed documents, which outlined the potential hazard, the measures to be put in place to minimise the risk and additional control measures. The risk assessment concerning aggression did state that there was a risk of the resident demonstrating ‘intimidation and harm to others’ but not how this should be managed. The additional control measures reiterated that the person should be encouraged to build relationships with others and should be encouraged “to join in social activities such as a befriending service, attending a day centre and work placement”, however, there was only evidence to show that a letter of referral to a day centre had been completed in February 2008. There was no follow up to this and no outcome. Similarly the risk assessment regarding potential abuse states that the resident should “work with psychologist to build up self confidence and assertiveness”. There was no evidence that psychologist support was in place for the resident, or that any therapeutic work had been undertaken in relation to self-esteem. During the course of the site visit to this service there was little engagement noticed between the staff team and residents. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 16 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities files have recently been introduced, and are intended to ensure care plan objectives/needs are highlighted and continuity of care is maintained to ensure resident’s needs are met. Unfortunately the activity files are blank, and the planned recruitment of the activities coordinator has not yet occurred. The residents at Abbeydale Care Centre are not appropriately supported to undertake activities, which would improve their quality of life. EVIDENCE: In discussion with residents it was apparent that they considered staff friendly and were generally satisfied with services, however there was little engagement with staff observed during the course of the day, although one resident commented they were satisfied with this level of staff support. Two residents were seen in the home during the day. A member of staff escorted one person to the dentist in the morning; however, during the rest of the Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 15 inspection even though there were two members of staff on duty, residents were either in the smoking room or their bedrooms by themselves. No meaningful or sustained interaction was observed. Activity files for a number of residents were examined, however these were all blank, and there was little or no record of rehabilitation activities undertaken, or review of progress noted in individual plans. Areas where staff would also record changes or improvements in independent living skills, which are an important focus of care planning, were also poorly documented. The daily care notes of one resident were examined in detail, and these demonstrated that although they had access to the community this was not in an engaged way, and there was no evidence of involvement in meaningful activities. For example, on 12/05/08 the resident went to the shops for ‘cigs and drink’; 13/05/08 the resident was ‘calm and stable and spent time in the smoking room’; 14/05/08 the resident ‘washed plate and cleaned up after eating’, ‘watched TV’, ‘went out to local shops’; 15/05/08 went to job centre, claimed they were assaulted by some people in the street, ‘later ran out to fight the people, followed by staff and brought back in hospital car’; 16/05/08 ‘in and out of the home’; 17/05/08 ‘wanted to buy clothes, given £25.00 bought a cap and spent the rest on take- aways’; 18/05/08 ‘watched TV, went in and out of the care centre, played some music in the games room, sat down with staff to do care planning exercise’. Etc. In their care plan, this resident had information about joining a befriending service, going to a day centre, showing interest in cooking, art, poster making etc. There was no evidence that any of these needs were addressed in the daily care notes. It was positive to note that resident’s are supported to maintain links with families and friends and that there is an open door policy in relation to visiting within the home. During the course of the inspection one resident spoken with stated that they had not had a key to their bedroom and that they had returned to their room to find a male resident in it. They stated that they repeatedly asked for a key and that it took a significant period of time for one to be provided. Similarly, Abbeydale Care Centre now has its own front door, however, this is locked and residents do not yet have keys to access it for themselves. In the daily care notes for one resident it states that on 15/05/08 the resident ‘…got up at 6.30 and asked staff to open the main door as (they) wanted to go out for a morning walk’. During the course of the inspection the front door was tried and was locked. The general manager of the hospital also stated during feedback, that residents have to ask a member of staff to open the front door for them. The communal bathroom is also locked and residents have to request that a staff member open the door for them if they wish to access it. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 16 No reason for the door being locked was given, however, residents do have an en-suite with toilet and shower facilities. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live in Abbeydale Care Centre have appropriate access to health care services. There is evidence in the care plan of health care treatment and intervention. Medication systems do not always follow good practice guidelines and a registered nurse is not on duty at night, which does not meet the national minimum standard for care homes with nursing and places residents at risk of their health care needs not being fully met. A request has been made for a Regulation Pharmacist to carry out an inspection of the management of medications at Abbeydale Care Centre. EVIDENCE: The AQAA received by Abbeydale Care Centre makes reference to health action plans and well man and well woman clinics, however, during the inspection of documents relating to health issues no information was seen regarding these and there was no evidence that any of the residents had been in attendance. The care plans for two residents were examined and these did contain clear documents recording the input from health care professionals. For example, one resident had records that stated on 13/05/08 they saw the Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 18 GP for blood monitoring, and on 16/05/08 they saw their consultant. It was positive to note that the consultant wrote the outcome of the visit directly onto the daily care notes. On the day of the site visit to this service a member of staff was escorting one resident to a dental appointment. The previous dental appointments and their outcomes were recorded in the person’s care plan. For one resident a weight-recording chart was in place, however this had started in May 2008, so there was only one entry. This was of concern as the person concerned was noted to have some issues with being over weight, and with eating junk food and take-aways. The medication procedure within the home was examined. Medication is stored in a locked cupboard attached to a wall within a small room. The medication fridge was locked, and the temperature recorded daily. However, on the day of the inspection the temperature was recorded as being –5 degrees Celsius and on 19/05/08 it was recorded as being –9 degrees Celsius. This is not within the specified temperature limit for the cold storage of medication, which is usually between 2 and 8 degrees Celsius. The medication room did not have evidence of daily temperature recording. It is important that this is undertaken, as many medicines require being stored within a specific temperature, which is below 25 degrees Celsius. If the temperature exceeds this limit the medication could become ineffective. The medication administration record file was examined. There was a staff signature sample list in place at the front of the file; however, there were no current photographs of individual residents attached to their section of the file. It was noted that one resident had all of their 18:00 medication omitted on 09/05/08 without reason. There was no signature on the MAR and no symbol of explanation. Most of the medication profiles were handwritten. These were vague, and did not always state the frequency of administration for the specific medication. I.e. the MAR stated the name of the medication and the dosage, but not whether this should be administered daily, morning and evening or when required etc. One resident had Diazepam 10mg tablets stored in the medication cupboard and the prescribing label clearly stated ‘when required’. This was not written on the medication profile in the MAR file and the resident was being given the drug on a nightly basis. This drug is therefore being administered contrary to its prescription and no ‘when required’ protocol was in place detailing when the resident might need the drug or why. A second ‘when required’ drug was also noted and again there was no protocol in place, nor was the reason for its administration recorded on the back of the MAR sheet. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 19 The handwritten profiles were not signed or double signed to prevent inaccurate recording. The controlled drug cupboard is inside the main medication cupboard and is made of metal. However, it is attached to a stud rather than a solid wall and is therefore in contravention of regulation. There are currently no CD’s within the care home however, it was positive to note that the CD register, when last used, was now being maintained appropriately. A requirement has not been made on this occasion as enforcement action is being considered. It was of concern to note that even though Abbeydale is registered as a care home with nursing, there is no registered nurse on duty at night. National Minimum Standard 20.9 states that only a registered nurse should administer all drugs in a care home with nursing. A requirement has not been made on this occasion as enforcement action is being considered. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints policy in place and some evidence that people who use the service feel that their views are listened to. However, there is no specific record of complaints at the home and there is not clear awareness of what constitutes a complaint. The people who live in the home are not adequately protected from harm. EVIDENCE: The home has adequate policies in place for the reporting and investigation of complaints; however, there was no evidence of this being put into practice within the home. For example, the complaints log was requested and the staff member stated that there was no log in place, as there had been no complaints. This was despite residents having made complaints in recent weeks on significant issues that affected their well-being i.e. one resident had expressed dissatisfaction at not having a key to their bedroom, and this was not quickly resolved, another resident had expressed dissatisfaction about the attentions of a female resident etc. Details of one complaint were recorded in the resident’s personal file but this was not clearly identified as a complaint with timescales and an outcome. One resident spoken with stated that they felt confident they were able to make complaints and raise issues if they needed to. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 21 In conversation with staff it was apparent they did not fully understand the difference between a complaint, a concern, or an allegation or what constituted a complaint, and what action should be taken to record, and investigate complaints. A requirement has not been made on this occasion as enforcement action is being considered. Staff members spoken with were able to demonstrate awareness of issues concerning adult abuse, and the procedure/action required in the homes procedures file to report incidents of abuse. The General Manager stated all staff had safeguarding training following the Requirements made in the last report, and plans were in place to repeat this training. However, no evidence was seen of this during the course of the inspection, and a copy of the home’s training matrix was requested, but did not materialise. In view of staff comments stated above this is welcomed, however it is recommended the training also reviews the action to be taken, and the recording and investigating of complaints by staff. One resident had who had been identified as being at risk of self-harm and absconsion from the home did not have risk assessments completed in relation to this. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the basic needs of the people who live there, however, it is not personalised and homely. EVIDENCE: Two inspectors undertook a tour of the premises. It was positive to note that there had been some changes in the environment. The home had been repainted in some areas and looked fresher. There were prints and paintings hanging on many of the walls, which brightened up the communal living areas. The small lounge area had been transformed into a games room with a snooker table and a CD player. Through this room was a lobby, with the front door to the premises. The door was locked. The dining area/ kitchenette had a TV in it and space where new lounge furniture will be placed when it arrives at the home. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 23 The environment still has an institutional feel to it and there are no curtains in the communal areas. It was of concern to note that double doors leading to the Abbeydale Independent Hospital Psychiatric Intensive Care Unit (PICU) were situated at one end of a corridor in the home. These doors were in frequent use, and people carrying large bunches of noisy keys were observed coming in and out of the care home using this entrance to access the main reception area of the building. This added to the overall institutional feel of the care home and to the feeling that Abbeydale is not seen as the home of the people that live there. One resident’s bedroom was looked at, and this had very little personalising artefacts within it. Overall the main part of the home was clean and tidy, however, the communal bathroom was examined and is still in need of deep cleaning. The toilet pan and exterior were dirty as were other surfaces and bins within the room. One survey received by a resident did state that they like their room and duvet. A second resident stated, “I like this place and I feel comfortable living here”. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff rosters are incomplete, do not provide sufficient information and demonstrate staff members work long days. Failure to deploy appropriately qualified staff at night is placing the well-being of residents at risk. EVIDENCE: The previous report stated the staff team currently working in the residential unit were made up of staff that also worked in the hospital, and that recruitment of a staff team to work exclusively in the residential care unit was underway. However, it was noted from staff rosters that a mix of staff – specifically registered nurses - are still used to staff the residential unit. This, along with rota’s that are planned week by week rather than in advance is of concern as it could have an impact on the residents receiving continuity in their care. A requirement has not been made on this occasion as enforcement is being considered. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 25 At the time of the site visit to this service two members of staff were on duty, one RMN and one support worker. During the morning the support worker escorted one of the residents to the dentist, leaving one RMN on duty in the home. Staff rosters demonstrated two staff, comprising of a registered nurse and a support/care worker are on duty between the hours of 08:30 and 21:15 each day. At night only two care staff are employed. In a care home with nursing, the national minimum standard states that a registered nurse should be on duty 24 hours a day. A requirement has not been made on this occasion as enforcement is being considered. Staff files were requested to review recruitment practices. Only five were provided, although a print out of Criminal Records Bureau checks of twelve other staff was provided. All of the staff recruitment files seen had a comprehensive application form, a two-day induction, two references, immigration checks/work permits and proof of identity (usually in the form of a photocopy of the persons passport). As stated at the previous inspection, there are no photographs of the employee’s retained on their files. There was no evidence of staff training seen during the inspection and the requested training matrix did not materialise. A requirement has not been made on this occasion as enforcement action is being considered. Supervision had been carried out with the staff team for Abbeydale Care Centre on one occasion in May 2008. The content of this supervision was sparse and based mainly around three questions ‘How well do you think you are performing?’ ‘What do you think you are lacking?’ and ‘How would you improve yourself?’. It was interesting to note that one member of staff had identified that they need more training, specifically NVQ3. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The evidence in this report, particularly in relation to staffing and medications management, indicates that the overall management arrangements are not sufficiently robust to protect the well-being of residents. EVIDENCE: The registered manager at Abbeydale Care Centre resigned from their post in January 2008 due to ill health. There has been a period of time whereby the Abbeydale Independent Hospital general manager has been managing the care home as well. However, a manager has now been appointed specifically to the care home. The AQAA received by the Commission does state a clear awareness of the need to recruit and register a manager at Abbeydale. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 27 The people living at the care home will benefit from a stable and competent management structure. Even though the home is only recently registered with the Commission, this focus and stability have been lacking at the home and this is reflected in the service currently being provided. The residents living within the home have completed quality assurance questionnaires. The questionnaire was designed in a part pictorial part written format which would allow for greater understanding. Two of these completed documents were examined. The first was positive about two areas and the smiley face had been ticked to reflect this. These areas were ‘You are consulted and involved in decisions’ and ‘You can be involved in the running of the home and have house meetings’. The resident was not sure about most of the questions asked and their overall comment was ‘poor’. A second resident was happy and satisfied with everything except ‘Are you involved in writing and changing your care plan’ about which they were unsure and in the section ‘Do you get help to go to work or college’ they had written “Not yet”. Their overall comment was ‘Very good’ and their comments stated “I need books for reading” and “I want to also see my brother”. The general manager stated during feedback that a report has not yet been compiled regarding their findings. He also stated that this information would be collated to see whether the home is running smoothly and in the resident’s best interests, and the results would eventually be generated into policy. The accident and incident books were requested. It was of concern to note that no accidents had been recorded and only one incident form had been completed. The incident form was in relation to a resident who had thrown furniture and their TV, and a Regulation 37 was sent to the Commission regarding this. However, other incidents have occurred within the home, such as one resident throwing a stand to the floor in the reception area and a second resident scalding themselves with hot tea. There was no evidence that these were noted as incidents or accidents within the home. The Commission did not receive regulation 37 notifications in relation to these either. According to the AQAA, all of the required equipment within the home has been serviced or tested and these are all in date. Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 1 15 3 16 1 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 2 X X 1 X Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered person must ensure that the information contained within the service user plan is put into practice to ensure the people that use this service have a good quality of life. Timescale for action 31/07/08 2. YA7 12(2) The registered person must 31/07/08 ensure that residents are enabled to take action regarding the decisions they make with respect to the care they receive to develop a good quality of life. The registered person must ensure that risk assessments are completed to enable residents to live as independently as possible, whilst also ensuring that there are safeguards in place to protect them. The registered person must ensure that residents are consulted with about their social interests and arrangements made for the residents to engage in these. DS0000069950.V364342.R02.S.doc 3. YA9 4(b) and (c) 31/07/08 4. YA12 16 (m) 31/07/08 Abbeydale Version 5.2 Page 30 5. YA14 16(m) (n) The registered person must ensure that residents are offered a programme of meaningful activities. This is in relation to residents stating what they would like to do, but this not being put into practice. The registered person must ensure that the wishes and feelings of residents are taken into account in relation to the care they are provided with. The registered person must ensure that the residents are protected from the possibility of harm or abuse. This is in relation to there being no evidence of staff training in safeguarding and to risk management plans not being in place for all areas of identified risk. The registered person must ensure that the care home is appropriate to the needs of the people that live there, that is, that it is less institutional in its approach and more homely and comfortable. 31/07/08 6. YA16 12(3) 31/07/08 7. YA23 13(6) 31/07/08 8. YA24 23(b) 31/08/08 9. YA30 16 (j) The registered person must 31/07/08 ensure that suitable arrangements are made for maintaining satisfactory hygiene levels at the home. This is particularly in relation to the communal bathroom, which was dirty. The registered person must ensure that an accurate rota is maintained at the home. 31/07/08 10. YA33 17(2) & Sch 4 Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 31 11. YA37 37 The registered person must 31/07/08 ensure that notifications of the death, illness or any other event that affects the well being of the residents must be made to the Commission in writing, without delay. The registered manager must ensure that the manager of the home applies to the Commission for registration. 31/07/08 12. YA37 9(1) & (2) 13. YA39 24(1)(2)(3) The registered person must ensure that information from the quality assurance system is communicated to the Commission and used as a tool to improve the service for the people who live there. 13 (4) The registered person must ensure that measures are in place to reduce hazards to resident’s safety, particularly in relation to the management of risks, and that these are implemented and maintained. 31/08/08 14. YA42 31/07/08 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 Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Abbeydale DS0000069950.V364342.R02.S.doc Version 5.2 Page 33 - 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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