Inspection on 01/02/08 for Abbeydale Nursing Home

This inspection was carried out on 1st February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbeydale Nursing Home 08/01/09

Abbeydale Nursing Home 31/07/07

Abbeydale Nursing Home 14/02/07

Abbeydale Nursing Home 26/04/06

Abbeydale Nursing Home 21/10/05

Abbeydale Nursing Home 02/06/05

Abbeydale Nursing Home 13/10/04

Abbeydale Nursing Home 13/05/04

Abbeydale Nursing Home 02/12/03

Abbeydale Nursing Home 05/09/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Abbeydale Nursing Home 88 Handsworth Wood Road Handsworth Wood Birmingham West Midlands B20 2PL Lead Inspector Brenda O’Neill Key Unannounced Inspection 09:30 1st February 2008 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 Abbeydale Nursing Home DS0000024813.V357858.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. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeydale Nursing Home Address 88 Handsworth Wood Road Handsworth Wood Birmingham West Midlands B20 2PL 0121 554 5024 0870 705 9966 Abbeydale@abbeydale.plus.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jagruti Patel Mrs Ifeoma Cecilia Ezeani Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 32 service users may reside in the home for the duration of the temporary measures, or until such time as any permanent additions have been approved and constructed. That three named service users can be accommodated in the home who are under 65 years of age. 31st July 2007 Date of last inspection Brief Description of the Service: Abbeydale Nursing Home is a period house that has been adapted and extended with a two-storey extension to create a home offering nursing care for up to 35 older people. Currently the home can only accommodate 32 people. The home is situated in a residential area of Birmingham. The railway station is nearby and the home is on a bus route. There is one main lounge on the ground floor plus two further small lounges and a dining room. There are sixteen single bedrooms plus eight double bedrooms and seven have en-suite facilities. However, all en-suite facilities are not suitable for people with mobility problems. There are assisted bathing facilities on each floor, but space is limited and they are not all suitable to meet the needs of the people living in the home. A passenger lift gives access to all floors. To the side of the main building there is a laundry where laundering of all linen and clothing is undertaken. The kitchen is situated on the ground floor and there is also a large garden situated to the rear of the home. The area at the front of the home is made over largely for car parking, which is limited and contains well established herbaceous and shrub borders. The home accepts people from a wide variety of cultural and ethnic backgrounds. Abbeydale Nursing Home DS0000024813.V357858.R01.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 1 star. This means the people who use this service experience adequate outcomes. Two inspectors carried out this key inspection over one day in February 2008. During the course of the inspection the files for two of the people living in the home were sampled as well as other care and health and safety documentation. The training and supervision of the staff were looked at and a partial tour of the home was undertaken. The inspectors spoke with three of the four people living in the home, the manager, owner and one member of staff. The home has a long history of a poor response to the requirements made by the Commission. They have not been able to consistently deliver a service that meets the needs and maintains the health and well being of the people living in the home. Between December 2006 and the previous key inspection in July 2007 there had been eight referrals to Social Care and Health under the Safeguarding Procedures. As a result of the serious nature and concerns of some of the referrals Social Care and Health made a decision to suspend placing any new people in the home in May 2007. Also arrangements were made for reviews of all the people who were residing in the home at the time to determine if their needs were being met adequately. Social Care and Health also undertook a monitoring visit to the home in June 2007 to assess practices. Social Care and Health forwarded a rectification notice to the proprietors in July 2007 advising them of the serious concerns and an action plan was requested asking them to detail how the issues/concerns would be addressed. The proprietors provided a comprehensive action plan and a follow up monitoring visit was undertaken in September 2007 to determine compliance with the action plan. The Commission also undertook a key inspection on 31st July 2007 and identified a number of shortfalls, requirements were made and an improvement plan was requested. At this stage nurses from the Primary Care trust commenced intensive visiting to the home, often visiting several times a day to monitor the conditions of the people living in the home, provide support and advice to staff where required to ensure the needs of the people living in the home were being identified and met. Since the inspection in July 2007 the Commission received concerns about the managers approach and attitude, the quality of the food and the lack of bathing facilities. This was passed to the proprietors to investigate. Their Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 6 investigation involved staff questionnaires and a meeting, but no real concerns were identified. In August 2007 an anonymous allegation of physical abuse to one of the people living in the home was received by the Commission, which implicated a member of care staff and the manager. It was referred to Social Care and Health under the Safeguarding procedures. The investigation involved the police and the majority of staff in the home were interviewed. As a result of the investigation no further action has been taken. Some complaints were also received about the working arrangements of staff in the home. It was identified that the manager, who was responsible for the duty rota, arranged for some staff to work excessive hours and in some cases staff were working consecutive day and night duty. It was also found that the duty rota did not always correspond with the record of hours worked by staff. Requirements were made to address the issues and working excessive hours puts residents and staff at risk. During this period Social Care and Health continued to monitor the home and regularly reviewed the contractual arrangements with the home. A decision was made to decommission the home and a meeting was held with the proprietors on 27th November 2007 to advise them of the decision and preparations commenced for moving the remaining people living in the home to alternative placements. At the time of visiting four residents remained in the home. CSCI believe that the low numbers of people living in the home, high staff ratio and the input from the Primary Care Trust are the reasons for the improvements in outcomes for the people living at the home. What the service does well: The four people living in the home at the time of this visit were receiving a lot of one to one time with staff. All the people living in the home appeared content and those that were spoken with were satisfied with the service they were receiving. Relationships between the staff and the people living in the home were good. One of the people living in the home told the inspectors the food was good and there was always enough to eat. Visiting was flexible enabling relatives to visit at a time that suited them and the people living in the home to maintain contact with them. The medication administration system in the home was well managed and ensured the people living in the home received their medication as prescribed. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 7 The daily records being written by staff were detailed and gave a good overview of the personal care being given to the people living in the home. The parts of the home occupied at the time were clean, well lit and warm ensuring the people living there were comfortable. What has improved since the last inspection? What they could do better: A contract of residence needed to be issued to all the people admitted to the home or their representative to ensure they had all the information they needed about the terms and conditions of their stay in the home. To ensure all the staff working in the home had the appropriate skills and knowledge to care for the people living there they needed to undertake training in dementia care. Care plans needed to be further developed so that staff knew what all the individuals’ needs of the people living in the home were and how they were to meet these. Care plans needed to be updated following reassessment, evaluation or change in the conditions of the people living in the home to ensure up to date information was available to everyone. The risk management plans needed to be comprehensive and updated as changes occurred to ensure the people living in the home were not exposed to any unnecessary risks. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 8 There needed to be evidence on site that the dietary needs of the people living in the home were being met in relation to their culture. The records of food being served to the people living in the home needed to be further developed so that it could be determined they were receiving a nutritious diet. If the home was to continue to be used as a care home further improvements were required to the environment to ensure it had all the appropriate facilities. To ensure the health and safety of the people living in the home and the staff were being maintained the registered manager needed to ensure that all equipment in the home was regularly serviced. 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 Nursing Home DS0000024813.V357858.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 Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The collection of information about individuals’ needs before they moved into the home was adequate enabling staff to determine if they could meet their needs. EVIDENCE: There had been no new admissions to the home due to Social Care and Health being in the process of withdrawing their contract with the home. At the time of this inspection there were four people living in the home. They had lived there for some time. At the time of the last key inspection the pre admission assessment process at the home had been found to be satisfactory however it was noted that one person had been admitted outside the registration category of the home. This issue had been resolved, as several of the people living in the home had been moved to other homes. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 11 A requirement was made at the last key inspection in relation to the people living in the home having contracts/terms and conditions of residence. The files for two of the people who remained living in the home were sampled. Only one of these included a signed copy of the terms and conditions of residence at the home this included details of the fees being charged and what was not included in these. At the time of the last key inspection in July 2007 there were a number of people living in the home with dementia. Not all staff had undertaken training in dementia care at this time which was essential to ensure they had the knowledge and skills to care for the people living in the home effectively. The files for the staff on duty at the time of the inspection were sampled. There was no evidence on these that they had undertaken this training. Therefore staff do not have the skills to meet individual needs. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had not been able to consistently deliver a service that met the personal and health care needs of the people living there without the support of nurses from the Primary care Trust. Care plans needed to be developed to ensure staff could care for the people living in the home in a person centred manner. Medication was well managed and the people living in the home were receiving their medication as prescribed. EVIDENCE: At the time of the last key inspection in July 2007 numerous concerns were raised about the ability of the home to meet the personal and health care needs of the people living in the home. At this stage nurses from the Primary Care Trust commenced intensive visiting to the home, often visiting several times a day to monitor the conditions of the people living in the home, provide support and advice to staff where required and to ensure the needs of the Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 13 people living in the home were being identified and met. The visits were continuing at the time of this inspection once or twice a day. A random inspection took place in December 2007 some improvements were noted at this time. Specific risk areas were inspected in respect of a sample of care plans e.g. tissue viability, behaviour etc. It was found that the risk assessments had been reviewed and some additions had been made to care plans or they referred to other documents in the folder. Further improvements were still needed to ensure the needs of the people living in the home were being met particularly in relation to pressure care and recording. Social Care and Health had made a decision in May 2007 to suspend placing any new people in the home and had notified the proprietors of the home in November 2007 that they were to decommission the home. At this time preparations commenced to move the remaining people who were living in the home to alternative placements. At the time of this key inspection there were only four people living in the home. The care for two of these people was tracked at this inspection. Both individuals had care plans on their files. The care plans were mainly generic with pre printed statements on them, for example, care plans for washing and dressing included the following statements, ‘assess and identify personal preferences’ ‘enable their independence’ ‘offer a time that is convenient to wash dress’ only addition specifically for one of the individuals was ‘…… has her toe nails cut every six to eight weeks by the chiropodist.’ This did not give any details about the person’s abilities, preferences or what staff would actually have to do to meet this individual’s needs in this area. The care plan was being evaluated monthly and the evaluation included much more information than the care plan, for example, this person had specific hair and skin needs which were in her evaluation but had not been put in the care plan. It was found that this was common for both of the people whose care was being tracked. The other individual had a care plan that stated they had mobility difficulties and that a wheelchair had been obtained. The most recent evaluation stated ‘mobilising independently with a stick’. When the manager was asked about this she stated that the evaluations were the care plans. The difficulty with this was that as more evaluations were added previous information would be lost. The manager was advised that the care plans must detail the specific needs, abilities, preferences and so on of the individuals and detail how staff are to meet the identified needs. The monthly evaluations should be identifying if the care plan needs have been met, if the care plan is effective and if anything has changed. If anything had changed since the last evaluation the care plan needed to be updated accordingly. There were a variety of risk assessments in place for the two people living in the home including manual handling, tissue viability, nutrition and personal safety. The quality of these varied considerably and again some had not been updated after changes identified in evaluations. One person had quite a well Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 14 detailed management plan in place for pressure care but it was evident from the evaluations this person’s condition had varied. For example, at one point being nursed in bed all the time, at another point she was getting up for a few hours a day. The most recent evaluation stated ‘continues to be nursed in bed 24 hours. Recently …… has been improving, health and balance so staff sit her out some days for a few hours’ this is a very contradictory statement in itself. The mobility care plan for this individual did detail how all moves were to be carried out by staff and the equipment to be used with the exception of the slide sheet that was seen in the individual’s bedroom. This was only mentioned in the evaluation and was to be used for repositioning the person. During 2007 Social Care and Health began reviewing the care needs of the people living in the home. During the period of reviews it was identified that the needs of two highly dependent people were not being met adequately in respect of tissue viability. As a result of the findings arrangements were made in consultation with family members to move them to alternative facilities where their needs could be met appropriately. At the time of the last key inspection some concerns were raised about the people who were nutritionally at risk or of low body weight. At the time of this inspection one of the people whose care was being tracked had no concerns but the other was diabetic and there were some concerns about nutrition. Care plans did give information about the individual’s diet and that any food was to be pureed. The food and fluid intake for this individual was being recorded. The daily notes for the individuals being case tracked were very detailed in relation to the care they were receiving and indicated their personal care needs were being met. It was also evident from the notes that any health concerns were being followed up appropriately. For example, there had been some concerns about the blood sugar levels of one of the individuals there was evidence that the G.P. had been contacted for this and that the nurses were profiling the blood sugar levels on an ongoing basis and the results were to be sent to the G.P. on completion. At the time of the last key inspection some issues were raised about the people living in the home having unexplained bruising and this had not been pursued. The records checked at this inspection did not indicate any incidents of unexplained bruising. Records also indicated that the people living in the home had access to the appropriate health care professionals as needed including, G.Ps, opticians, chiropodists, dentists and district nurses as well as more specialised visits from occupational therapists and physiotherapists when needed. The medication system in the home was being well managed for the four people living in the home. Regular audits were being undertaken of the medication held in the home, copies of prescriptions were available and there were specimen signatures available for the nurses administering medication. MAR (medication administration records) charts were being appropriately Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 15 completed with all incoming medication acknowledged and any balances of medication being brought forward to the next MAR chart. The majority of the medication was being administered via a 28 day monitored dosage system but there were some boxed tablets. All of these were audited and all the balances held in the home were correct. Staff were observed to knock on bedroom doors before entering and spoke to the people living in the home with respect. Relationships appeared friendly. Where people were able to specify their preferences they were able to spend time in the privacy of their bedrooms if they wished and this was observed on the day of the inspection. There was an indication on some of the care plans that consent should be gained from people before they were moved and staff should indicate what they are doing. The four people remaining in the home were appropriately dressed, clean and tidy. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were no rigid routines and visitors could visit at times that suited them enabling the people living in the home to maintain contact with them. It could not be evidenced that the social care needs of the people living in the home were met. Food records did not evidence that the cultural needs of the people living in the home were being met. EVIDENCE: As there were only four people living in the home at the time of this inspection they were getting a considerable amount of one to one staff time. At the start of the inspection two of the people living in the home were in the lounge and two were in their bedrooms. The two people sitting in their bedrooms were watching television they were quite content and were satisfied with the service they were receiving. One had recently had a new television and spoke to the inspectors about this. He was also aware that he was going to move from the home and told the inspectors where he was expecting to go but that he had not seen it yet as it was not fully Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 17 built. He stated he was happy with the food in the home and that there was always enough food. The care plans for the people living in the home included a section for spiritual/social/cultural needs but these were very general and did not inform staff how they were to meet any identified needs. For example, ‘encourage visits/ascertain if she wants to practice her religion. Encourage minister to visit as she cannot travel to church. … will be encouraged to express her opinions or matters that affect her culture.’ The evaluations of the care plan evidenced some visits from family members and stated that she likes listening to a certain type of music but there was no evidence that she had been enabled to do this. The manager stated that this was done and the person often listened to this music when in her room but staff were not recording this. Although staffing had been reduced due to the people moving out the activities co-ordinator was still employed at the home. She was seen undertaking some domestic duties and then spending time with two of the people living in the home playing dominoes. There was little evidence of stimulation in daily records with the exception of statements such as ‘tried to socialise with staff’ and records of when individuals had visitors. There did not appear to be any rigid rules or routines in the home and the people that were able to move around the home on their own were seen to do so without any restrictions put on them. They were able to make some choices in their daily lives, for example, when to get up and go to bed and what to do with their time. If they wanted to spend time in their rooms this was not an issue. The cook was still employed at the home at the time of the inspection. The cook was aware of the medical diets that were required by the people living in the home for diabetes and a pureed diet and was able to indicate how the diabetic diets differed from normal diets. The inspectors were told that the menu was rotated on a weekly basis which would not give the people living in the home much variety. There was a four week menu at the last key inspection. The records of food being served to the people living in the home were sampled. They indicated there was some repetition particularly of vegetables, puddings were not always being recorded and there was no evidence that two of the people living in the home were being offered culturally appropriate foods. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to the ongoing concerns being raised about the home it cannot be evidenced that the people living in the home are appropriately safeguarded. The proprietor had co operated with vulnerable adults investigations and staff had received training in adult protection issues to help resolve the issues being raised. EVIDENCE: Since the inspection in July 2007 the Commission received concerns about the managers approach and attitude, the quality of the food and the lack of bathing facilities. This was passed to the proprietors to investigate. Their investigation involved staff questionnaires and a meeting, but no real concerns were identified. In August 2007 an anonymous allegation of physical abuse to a person living in the home was received by the Commission, which implicated a member of care staff and the manager. It was referred to Social Care and Health under the Safeguarding procedures. The investigation involved the police and the majority of staff in the home were interviewed. As a result of the investigation no further action has been taken. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 19 Some complaints were also received about the working arrangements of staff in the home. It was identified that the manager, who was responsible for the duty rota, arranged for some staff to work excessive hours and in some cases staff were working consecutive day and night duty. It was also found that the duty rota did not always correspond with the record of hours worked by staff. Requirements were made to address the issues and working excessive hours which puts the people living in the home and staff at risk. During this period Social Care and Health continued to monitor the home and regularly reviewed the contractual arrangements with the home. A decision was made to decommission the home and a meeting was held with the proprietors on 27th November 2007 to advise them of the decision and preparations commenced for moving remaining residents to alternative places. A complaints log had been started at the home since the last inspection. None of the concerns detailed above were included in the complaints log. Only one complaint was detailed which had been raised by a member of staff in relation to not having adequate supplies of incontinence aids and soap available and which of the people they were to get up in the morning. The manager had investigated this and parts of the investigation were documented. The proprietor had co operated with vulnerable adults investigations and staff had received training in adult protection issues to help resolve the issues being raised. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been some improvements in the environment and décor, so improving the comfort and facilities for the people living in the home. EVIDENCE: At the time of the random inspection in December some improvements had been made to the environment. Windows had been replaced, cladding to the exterior of the home and painting had been undertaken. All areas inspected appeared adequately lit. The bathroom opposite the nurse’s station was in the process of being made into a floor level shower and the bath hoist in the first floor bathroom had been replaced, so enhancing the bathing facilities in two areas of the home. At the time of the previous key inspection work was being undertaken in respect of electrical sockets in the bedrooms and this had been completed, so providing two double sockets in bedrooms. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 21 A portable ramp had been provided, because the home did not have disabled access, that was stored behind a chair in the reception area, but can be used for wheelchair users to enter and leave by the front door. Due to the replacement of windows some areas needed redecoration and two rooms had already been redecorated. The proprietor stated that when the work was completed on the windows a programme of redecoration would be undertaken over the next three months for the remainder of the home. At the time of this inspection only the areas being used by the four people remaining in the home were toured. There had been further redecoration since the random inspection and all areas seen were generally acceptable, clean and well lit. The floor level shower on the ground floor of the home had been completed and the four people who remained living in the home were using this. There was one broken tile in this room but this was replaced before the inspectors left the home. The shower was running at an acceptable temperature on the day of the inspection. The adequacy of the bathing and shower facilities in the home will have to be assessed depending the use of the home in the future. The communal areas being used at the time of the inspection which included a large lounge and dining area were adequately furnished and decorated. If the building is to be used as a residential facility in the future the other communal areas will need to be reviewed as detailed in the previous key inspection report. The bedrooms that were seen varied in size and were personalised to some degree. Some of the rooms were quite small. One of the people living in the home was in a double room but he was the only occupant. Bedrooms were reasonably decorated and there was evidence that moving and handling and pressure relieving equipment was available as required. The laundry was not inspected during this visit. The kitchen was clean and tidy and the food in the fridges and freezers was adequately labelled. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Appropriate staffing levels were being maintained to meet the needs of the people living in the home. Staff files indicated staff had undertaken a variety of training to enable them to care for the people living in the home appropriately. EVIDENCE: Several issues were raised at the last key inspection in relation to staff training and team working at the home. At the time of the random inspection in December all the outstanding issues were looked into. Staff training and recruitment records were checked and three staff were interviewed. Staff training had improved vastly at the time of the random inspection and staff indicated they had received training in a variety of topics including, fire training, manual handling, health and safety and protection of vulnerable adults. Some staff had undertaken tissue viability training and others were still waiting to undertake this. Staff had undertaken appropriate induction training. The staff interviews and the observations made at the time of the random inspection indicated that staff understood their roles and responsibilities and had the necessary skills to fulfil their roles. It was also determined at this inspection that teamwork in the home had improved. No issues were raised at the random inspection in relation to the recruitment of staff. At the time of this inspection no new staff had been employed and the Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 23 numbers of staff had reduced as the people living in the home had moved to other facilities. Staffing levels were found to be appropriate with two staff being on duty throughout the day and night one of these being a qualified nurse. Ancillary staff were also still available in the home. Staff did not appear to be working excessive hours as was indicated at the last key inspection. The training matrix for the home was seen and this indicated that staff had generally had the required updates for their mandatory training. Due to the position of the home with all the people living there being moved to other facilities training input had been reduced. The manager stated that all staff had either NVQ level 2 or 3. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not run in a way that ensures the best interests of the people living in the home are maintained. EVIDENCE: The registered manager and the owner of the home were present for the majority of the inspection. The home has a long history of a poor response to the requirements made by the Commission. They have not been able to consistently deliver a service that meets the needs of the people living in the home and maintain their health and well being. A decision was made by Social care and Health to decommission the home and a meeting was held with the proprietors in November 2007 to Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 25 advise them of the decision and preparations commenced for moving remaining residents to alternative placements consequently there were only four people living in the home at the time of this inspection. The owner of the home was clearly unhappy about the decision made to decommission the home and felt she had not had enough information as to why this had happened. Concerns have been raised about the management of the home since the last key inspection and the manager had been working under supervision for three months. The home had recently been informed by Social Care and Health that this was no longer required. Complaints had also been raised about the working arrangements of staff in the home, for example, staff working excessive hours. Requirements were made to address the issues and most had been met at the time of this inspection. Improvements were still required in the care planning at the home and ensuring all documentation was up to date and in meeting the social care needs of the people living in the home. The manager and owner stated there was a quality monitoring system in the home when such things as care plans, risk assessments, bedrooms and equipment were audited but this had ceased due to the current situation in the home. The proprietor was undertaking her visits in relation to regulation 26 until November 2006 but stated that since then she had been attending the home on a daily basis to support the manager and had therefore not been doing the reports. The financial records for the people living in the home at the time of the inspection were not viewed. The manager stated Birmingham City Council managed their finances. There were no outstanding requirements in relation to this. At the time of the random inspection in December staff indicated they were receiving supervision with the manager of the home. At the time of this inspection there was evidence that this had been sustained. There was evidence on site that the majority of the equipment in the home had been serviced regularly with the exception of the nurse call system and the gas equipment. Evidence of current servicing for both of these needed to be forwarded to the CSCI. No evidence was seen that the electrical wiring in the home had been checked for worthiness. All the in house checks on the fire system were up to date and the water system had been checked for the prevention of legionella. Only one accident had been recorded since the random inspection. This had been appropriately documented. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 X X 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 3 X 2 Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 2 Requirement A contract of residence must be provided to all the people living in the home and their representatives. This will ensure the people living in the home are provided with all the information about the terms and conditions of their stay in the home. Timescale of 30/4/07 and 04/12/07 not met. All staff must receive training in caring for people with dementia commensurate with their position in the home. This will ensure staff have the appropriate skills and knowledge to care for the people living in the home. Timescale of 30/10/05 not met. Time scale of 30/03/08 not expired. All care plans must: Detail the individual needs of the people living in the home and how they are to be met by staff. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 28 Timescale for action 01/02/08 2. OP4 12(1) 18(1) 30/03/08 3. OP7 12(1) 14/03/08 Be updated following reassessment, evaluation or change in the conditions of the people living in the home to ensure up to date information is available to everyone. Previous time scale of 30/12/07 not met. This will ensure the people living in the home receive person centred care. The management plans that are in place for any identified risks must be comprehensive and be updated as changes occur. This will ensure the people living in the home are not exposed to any unnecessary risks. Staff must be provided with training in respect of handling aggression. This will ensure the people living in the home and the staff are safe. Previous time scale had not expired. There must be evidence on site 14/03/08 that the dietary needs in relation to the culture of the people living have been met. This will ensure that the people living in the home are receiving the appropriate foods. The record of complaints must clearly indicate the nature of all complaints, the investigation, the outcome and resolution. Previous time scale of 20/12/07 not met. This will ensure all complaints Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 29 4. OP8 13(4) 14/03/08 5. OP8 18(1) 30/03/08 6. OP15 12(4)(b) 7. OP16 22 14/03/08 8. OP20 23(2)(g) raised are recorded and have been managed appropriately and people are confident their views are listened to. Plans with timescales for 31/03/08 extension to the communal space should be forwarded to the Commission. Timescales since May 2004 not met This will ensure there is adequate communal space for the use of the people living in the home. A record of up to date PIN numbers must be kept in the home for all nurses. Evidence of staff eligibility to work must be available for inspection. This will ensure the people living in the home are safeguarded. Time scale of 04/12/07 not assessed on this visit. Evidence must be forwarded to the CSCI that: The emergency call bell system. Previous time scale of 04/12/07 not met. The gas equipment. The electrical wiring. Have been serviced/checked at the required intervals. This will ensure the safety of the staff and the people living in the home. 9. OP29 19 31/03/08 10. OP38 13(4) 17(2) 23(4)(c) (iv) 14/03/08 Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP8 Good Practice Recommendations Comprehensive care plans should be in place detailing the social care needs of the people living in the home and how these are to be met by staff. The people living in the home should be consulted about their wishes in respect of bathing and suitable arrangements put in place to meet their needs. Not assessed on this visit All the people living in the home should be offered a choice of G.P to ensure their preferences are respected. Not assessed on this visit. All staff working in the home, as carers must be able to speak English effectively to ensure they can identify the needs and requests of the people living in the home. Not assessed on this visit. Effective behaviour monitoring should be undertaken where individuals are displaying aggressive behaviour. Not assessed on this visit. Arrangements must be put in place to provide the people living in the home with a range of suitable activities both in house and outside the home to meet their needs. Records of activities undertaken by the people living in the home should be maintained to evidence their social care needs are being met. The record of food should be comprehensive for each meal taken by the people living in the home. This will ensure it can be determined if people are receiving a nutritious diet. The remainder of the garden is cleared and made fit for use by the people living in the home. Not assessed on this visit. Suitable arrangements are made to ensure the safety of the wall on the patio area. Not assessed on this visit. Suitable bathing facilities must be available in all areas of the home prior to any new admissions to the home. This will ensure there are enough facilities available for the people living in the home. DS0000024813.V357858.R01.S.doc Version 5.2 Page 31 3. 4. OP8 OP8 5. 6. OP8 OP12 7. 8. OP15 OP19 9. OP21 Abbeydale Nursing Home 10. OP23 11. 12. OP24 OP25 13. 14. OP25 OP26 15. OP33 Information must be provided as to when the small double room will revert to a single room prior to any new admissions to the home. This will ensure adequate bedroom space for the individual using the room. All the people living in the home should be provided with lockable facilities to store confidential items or medication. A review of all privacy curtains in double bedrooms should be undertaken and action taken to ensure they are suitable to surround beds and provide privacy to the people occupying the rooms. Not assessed on this visit. The people living in the home should have facilities in their bedrooms to enable them to adjust the temperatures of radiators to suit their preferences. Robust systems for the laundry must be in place to ensure that the people living in the home receive their own clothing back that is clean and in a timely manner. Not assessed on this visit. The quality assurance process must be developed further to include feedback from all stakeholders regarding the home and draw up an action plan indicating developments and outcomes for the people living in the home. Not assessed on this visit. Abbeydale Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Nursing Home DS0000024813.V357858.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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