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Inspection on 31/07/07 for Abbeydale Nursing Home

Also see our care home review for Abbeydale Nursing Home for more information

This inspection was carried out on 31st July 2007.

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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

On discussion with residents they stated they were happy living in the home. The home admits residents from a range of cultural backgrounds and the cultural mix of residents is also reflected in the staff group. They provide a choice of meals including cultural options to meet resident`s needs. Visiting is flexible enabling relatives to visit at a time that suits them and residents to maintain contact with them. Visitors stated "They give me a drink when I visit", "I had lunch on Christmas day here and I stayed overnight when the weather was bad". Residents are able to bring personal items of furnishings etc. into the home in order to personalise their rooms and make them more homely. The medication system was of a good standard, so ensuring residents receive medication prescribed

What has improved since the last inspection?

The majority of the garden has been cleared and paving slabs laid plus table and chairs have been provided on the patio area, so that residents can use it when the weather permits. Locks have been fitted to toilets, bathrooms and bedrooms doors, so enhancing the arrangements for resident`s privacy. At the time of inspection double electrical sockets were being fitted in bedrooms, so providing additional sockets for the use of electrical equipment in bedrooms. Some minor repairs and servicing of equipment had been undertaken since the last inspection, so enhancing health and safety in the home. Some new armchairs and pressure relieving equipment purchased, so improving the equipment in place to reduce the risk of pressure sores. Work was being undertaken in the laundry to improve the environment, so meeting hygiene standards. The requirements made by the Environmental Health Officer had been addressed, so improving hygiene standards in the kitchen. New cupboards had been fitted in the medication and domestic rooms, so improving arrangements for storage.

What the care home could do better:

Although there had been some progress with the requirements since the last inspection there are still a number of areas that need to be addressed to ensure residents well being and they are safeguarded. There needs to be a more pro-active approach to care with monitoring, early identification of concerns and appropriate referral to health professionals to ensure residents health care needs are met. The systems for dealing with concerns and complaints needs to be reviewed, all concerns/complaints recorded, investigated and acted upon to ensure residents are adequately protected and learning is achieved to lead to continued improvements. The assessment and care planning process needs to be enhanced to ensure resident`s needs are identified and consistently met by staff who are familiar with the agreed plan of care. There needs to be more attention to detail in meeting residents personal and nursing care needs whilst respecting their dignity and following their wishes. Suitable assisted bathing facilities must be available to enable residents to have a bath or shower when they wish. The arrangements for activities must be reviewed and developed both in the home and outside to ensure residents are adequately stimulated. Further staff training is required to ensure staff have the appropriate skills and knowledge to care for residents effectively. The shortfalls in respect of team working and communication needs to be addressed to ensure resident`s needs are met and outcomes are positive by a fully committed and positive staff group. The arrangements for staff supervision need to be developed further to ensure staff receives appropriate support and training both inside the home as well as from external training courses. Some areas in respect of the maintenance and servicing of equipment need to be addressed to ensure a safe environment for residents. Also the lighting must be reviewed and enhanced where necessary to meet resident`s needs and prevent occurrence of accidents, The quality assurance system needs to be reviewed and developed further and where any issues are identified by residents or stakeholders action must be taken to address them.

CARE HOMES FOR OLDER PEOPLE Abbeydale Nursing Home 88 Handsworth Wood Road Handsworth Wood Birmingham West Midlands B20 2PL Lead Inspector Ann Farrell Unannounced Inspection 09:30 31st July 2007 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.V340120.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 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.V340120.R02.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) Mr Jitendra 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.V340120.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 14th February 2007 2. 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 residents. 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 residents with mobility problems. There are assisted bathing facilities on each floor, but space is limited and they are not all suitable to meet resident’s needs. 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 residents from a wide variety of cultural and ethnic backgrounds. Fees range from £410 to £525 per week, inclusive of the nursing element, which is paid by the Primary Care Trust. Fees do not include the cost of newspapers and delivery, taxi, staff escorts, telephone calls, clothing, name tags, toiletries, chiropodist, hairdresser etc. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social care inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development The inspection was conducted over two days commencing at 7.15am on the second day of the inspection and the home/provider did not know we were coming. This was the first statutory key inspection for 2007/2008 and the manager plus the proprietor were present for the duration of the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection; on the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home plus conversation with managerial and care staff plus visitors and some residents. A number of residents were unable to communicate their views verbally to the inspectors so direct and indirect observation was used as part of the inspection process. One of the inspectors also used the Short Observational Framework (SOFI) process to inform the process. This process involves time spent in the lounge watching how the care staff looked after residents and also how residents spent their time. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Written and verbal comments were also received from relatives and health professionals. Over the past year there have been eight referrals to Social Care and Health Department under the adult protection procedures, some of which are currently being investigated. Due to the serious nature of the concerns Social Care and Health and the Primary Care Trust have suspended contracts, so no new residents are being admitted to the home and two residents are to be moved to alternative accommodation. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The majority of the garden has been cleared and paving slabs laid plus table and chairs have been provided on the patio area, so that residents can use it when the weather permits. Locks have been fitted to toilets, bathrooms and bedrooms doors, so enhancing the arrangements for resident’s privacy. At the time of inspection double electrical sockets were being fitted in bedrooms, so providing additional sockets for the use of electrical equipment in bedrooms. Some minor repairs and servicing of equipment had been undertaken since the last inspection, so enhancing health and safety in the home. Some new armchairs and pressure relieving equipment purchased, so improving the equipment in place to reduce the risk of pressure sores. Work was being undertaken in the laundry to improve the environment, so meeting hygiene standards. The requirements made by the Environmental Health Officer had been addressed, so improving hygiene standards in the kitchen. New cupboards had been fitted in the medication and domestic rooms, so improving arrangements for storage. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 7 What they could do better: Although there had been some progress with the requirements since the last inspection there are still a number of areas that need to be addressed to ensure residents well being and they are safeguarded. There needs to be a more pro-active approach to care with monitoring, early identification of concerns and appropriate referral to health professionals to ensure residents health care needs are met. The systems for dealing with concerns and complaints needs to be reviewed, all concerns/complaints recorded, investigated and acted upon to ensure residents are adequately protected and learning is achieved to lead to continued improvements. The assessment and care planning process needs to be enhanced to ensure resident’s needs are identified and consistently met by staff who are familiar with the agreed plan of care. There needs to be more attention to detail in meeting residents personal and nursing care needs whilst respecting their dignity and following their wishes. Suitable assisted bathing facilities must be available to enable residents to have a bath or shower when they wish. The arrangements for activities must be reviewed and developed both in the home and outside to ensure residents are adequately stimulated. Further staff training is required to ensure staff have the appropriate skills and knowledge to care for residents effectively. The shortfalls in respect of team working and communication needs to be addressed to ensure resident’s needs are met and outcomes are positive by a fully committed and positive staff group. The arrangements for staff supervision need to be developed further to ensure staff receives appropriate support and training both inside the home as well as from external training courses. Some areas in respect of the maintenance and servicing of equipment need to be addressed to ensure a safe environment for residents. Also the lighting must be reviewed and enhanced where necessary to meet resident’s needs and prevent occurrence of accidents, The quality assurance system needs to be reviewed and developed further and where any issues are identified by residents or stakeholders action must be taken to address them. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 8 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.V340120.R02.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.V340120.R02.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): 1,2,3,4,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information was available to enable residents or relatives to make a choice about whether the home is suitable for their needs. The collection of information about residents needs before they move into the home was adequate enabling staff to determine if they could meet resident’s needs. EVIDENCE: The home generally admits residents who require long term nursing care. There was a service user guide available for prospective residents providing them with information about the facilities and services. The management have recently provided a shortened version for easier reference. These were available on entering the home with a copy of the most recent report from the Commission, so providing information for prospective residents and their families to make an informed choice about moving into the home. However, Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 11 there was no copy of the contract outlining the terms and conditions of stay, the fees or a summary of the complaints procedure included. Copies of the service user guide were also available in bedrooms for residents to look at in their own time. The information outlined above should be included in the service user guide to ensure people have all the information they require before moving into the home. At the last inspection there was no evidence of a contract of residence for residents outlining the terms and conditions. The action plan provided by the management team following the inspection stated there was a contract for all residents and they had been in place for some time. On this inspection it was stated by the manager and the accountant that copies of contracts had been sent to all families for signing in July 2007 and they were waiting for a number of them to be returned. On inspection of a sample of files there was only one contract available. The accountant stated that fees were made up of contributions from the Local Authority and the Primary Care Trust where residents were funded and no one was paying any form of top up. This area remains outstanding from previous inspections and will need to be addressed. A copy of the contract should be retained on the residents file in the home A small sample of resident’s files was inspected to determine the admission process. It was found that a pre admission assessment had been completed for a resident, which was adequate and staff had written to confirm that they could meet the person’s needs. However, it appears that the resident suffered with mental health problems and the home is not registered to care for this group of residents. The management team must ensure that in future no residents are admitted outside the homes category of registration unless the Commission is consulted first, so that they can be assured the residents needs can be met appropriately. The home has a number of residents who suffer with dementia. Previous inspections have identified that training was required in this area in order to provide staff with the knowledge and skills to care for residents. Some training has commenced in this area. Some of the rooms are small, toilets, en-suite and assisted bathing facilities have limited space and it would be difficult to manoeuvre equipment such as hoists for manual handling. The manager of the home must ensure that when assessing residents for admission to the home these factors are taken into consideration and ensure residents needs can be met by the facilities available. It is recommended that a review be undertaken in respect of signage and decoration of communal areas of the home in relation to the needs of residents with dementia. Different rooms and areas should look different, so residents with dementia have their independence promoted and avoid unnecessary difficulties. The parts of the home with the original Victorian features do look different and unique, however other parts of the building could prove difficult Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 12 to these residents. Improvements in signage and different colours for various areas and doors are required so that residents can distinguish between them to aid orientation and independence. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 13 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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning need developing to ensure all residents’ needs are identified and met in a consistent and appropriate manner. Residents health care needs are not consistently met in an effective manner and there needs to be a more proactive approach to care and follow up to ensure residents well being is maintained. Medication systems were generally of a good standard so ensuring residents receive the medication prescribed by health professionals. EVIDENCE: Following admission to the home staff had completed a range of risk assessments in respect of tissue viability, nutrition, manual handling, the use of bedrails etc. but they had not been reviewed on a regular basis. There was no further assessment to inform the care plan and it would appear that staff had relied on the basic information from the pre admission assessment, which did not give enough information about the resident’s needs or any significant information as to how they could be met. Assessments had been undertaken Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 14 in respect of mental health and continence. It was found the mental health assessment was vague and it was disappointing as the manager stated one of the nurses was a registered nurse in respect of mental health. Issues were raised in respect of the continence assessment, but generally continence management appeared to be with the use of pads rather than exploring alternatives. There was no evidence that the resident or any other significant person such as relatives, G.P. hospital staff etc. had been involved in the process to provide relevant information about the residents needs, wants and preferences. There must be comprehensive assessments to ensure that resident’s needs are identified and suitable action is put in place to meet the needs. A care plan is drawn up for residents following admission to the home outlining the action required to meet resident’s needs. The response from the providers following the last inspection stated that the manager ensured that each resident had a care plan that reached the standard and at the commencement of the inspection the manager stated all care plans were up to date. Both inspectors reviewed care plans independently and found similar shortfalls that included; records contained vague instructions on how to meet residents individual needs e.g. supervise when transferring and moving, two staff and the hoist to be used, encourage adequate diet and fluids, encourage to socialise, change residents position. Care plans were not updated when changes had been noted e.g. where a resident was bed bound it stated to offer mobility aid and to be moved in a wheelchair; where a resident was receiving feeding through a tube the care plan did not indicate the correct regime for the feeds despite it being changed in October 2006. The care plans were not comprehensive e.g. in some cases there was no indication that a resident was diabetic, the arrangements for personal hygiene or tissue viability. Also there was repetition, statements of what was to be done, but not how staff were to achieve it and short-term care plans were not always available. There was no indication of involvement of the resident or their representative to include their preferences in the care plan. Without a comprehensive care plan it cannot be guaranteed that residents needs will be fully met in a consistent manner. Action will need to be taken by the management team to address these issues and training provided where necessary. Since the previous inspection arrangements have been made for all residents to be registered with one G.P. who visits the home on a weekly basis and when required. Although this may enable more consistency to residents and the home, residents should be offered a choice of G.P. when admitted to the home. Records included separate sheets to indicate visits by the G.P. and other health professionals. There was evidence of visits by the G.P, optician and chiropodist and dentist and the tissue viability nurse specialist. The inspectors could not evidence records to demonstrate that residents with chronic diseases such as diabetes; asthma and high blood pressure etc. were receiving regular health checks in order to monitor adequate control and identify any complications. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 15 The manager stated that she was in the process of identifying residents with chronic diseases, so they could be referred to the G.P. for follow up. However, this area has been outstanding since 30th December 2005 and the action plan following the last inspection stated the G.P. was involved in this and it was ongoing. It appears from the inspection that this is not happening and this will need to be followed up to ensure resident’s health is managed effectively. During the inspection it was noted that staff were completing turn charts and fluid charts on a regular basis to demonstrate the care provided to residents, so ensuring residents receive the adequate care in these areas. The care plans stated oral care would only be given once a day to residents who were unable to eat and drink and there were no records in relation to oral care being given. Where residents are not able to eat oral care should be given more frequently to keep the mouth clean and reduce the risk of any infections. Following an audit by the tissue viability service the home had purchased a number of pressure relieving mattresses and armchairs for residents. The management team were unable to confirm if they had purchased all the equipment. An audit will need to be undertaken and action taken if they have not been purchased. Whilst touring the home a number of pressure relieving and pressure reduction mattresses were in place plus a number of new chairs. However, the chairs were not to the full recommendations made by the tissue viability nurse and staff were using incontinence sheets on them. On discussion with the manager she stated the tissue viability nurse had stated the practice was satisfactory. However, the issue had been brought up with the tissue viability nurse, who was visiting at the time of inspection, and she advised the inspector that she had already spoken to the home about this poor practice, as it was not suitable. The management team must ensure these are not used as they are an infringement on resident’s dignity and they must ensure suitable arrangements are in place for management of resident’s continence. There were residents who had pressure sores for some time and staff have been liaising with the tissue viability nurse. However, upon a recent visit by the tissue viability nurse she found the wounds had deteriorated and were infected, but staff had not contacted her about them. She arranged for appropriate treatment to be implemented and the concerns were referred to Social Care and Health under the Adult Protection procedures. On inspection of the records there was no record of a doctor visiting and prescribing treatment prior to her visit. Although there was evidence of medication charts for treatment there were no copies of prescriptions. This is concerning as it was not possible to track the care given to residents. Staff had been provided with training in respect of tissue viability in the past and at the last inspection concerns were raised about the lack of preventative strategies in relation to tissue viability. The management team responded by saying they would work Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 16 closely with the tissue viability nurse and adhere to local guidance in respect of pressure sore prevention. It was concerning that this had not occurred. At the beginning of the inspection the manager stated all residents had their own slings where they required the assistance of a hoist for moving and slide sheets for moving in bed. On inspection it was found that residents did not have individual slings, even where they had been identified as having an infection. Some of the slide sheets were short and in one care plan it stated a resident should be moved in bed with a long slide sheet to prevent risks to their heels. In some care plans it stated to use certain pieces of equipment for manual handling, but on discussion with staff and residents different accounts of the equipment used was given. At one stage it was also noted that staff were moving residents out of a wheelchair without securing the brakes, so putting them at risk of an accident and on occasion poor manual handling techniques were observed. Records indicated that one resident refused to use pieces of equipment and staff were using a controversial draglift. This puts the resident and staff at risk of injury. The manager stated that this was acceptable if staff agreed to use it and that all staff had agreed, but there was no evidence of this. Where conventional methods of moving and handling are not possible the staff must demonstrate that they have explored all avenues such as using other people to spell out the risks such as physiotherapist, G.P. family, social worker. If the resident still refuses and staff display willingness to use controversial methods then each member of staff needs to sign a disclaimer regarding the risks to their health and inability to claim against any injury. The resident or their family must also confirm in writing that if any wounds are incurred due to the method of moving no action will be taken by the family. Concerns about manual handling procedures were raised at the last inspection and the homes response indicated that plans were in place, all staff were aware of them through staff handovers, training, staff supervision and the manager had completed manual handling training for trainers in order to train all staff. It is concerning that areas of practice remain poor as it puts staff and residents at risk of injury. At the last inspection concerns were raised about residents who were nutritionally at risk or of low body weight. Staff had identified some residents who were at risk and were providing fortified milk at breakfast time. On discussion with the manager she stated they started the process at breakfast, but such residents should be given fortified drinks or snacks throughout the day. On inspection of the records of one resident there was no evidence that staff were monitoring the residents food and fluid intake in order to determine if they were having an adequate nutritious intake despite being assessed as at risk. Where concerns are identified with resident’s weight or dietary intake; the food and fluid intake should be monitored to determine if a referral to a health professional is required. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 17 It was noted that a number of residents were given a puree diet. However, two of these residents were observed to be eating solid food items. It was recommended that this area be reviewed and action taken to ensure residents receive an appropriate diet to meet their need and reduce the risk of choking. At previous inspections concerns were identified with wheelchairs and it was stated that referrals had been made regarding assessments for appropriate wheelchairs. Some residents had received new wheelchairs; so ensuring they have appropriate equipment to meet their needs. The accident book was inspected and it was found that a resident had sustained a head injury and no observations had been undertaken following the incident. The Commission had not been informed of some of the accidents/incidents that had occurred as required under the regulations. There had also been an incidence of unexplained bruising and no action had been taken. In such cases the social worker should be informed and an investigation undertaken to determine the cause, so that preventative strategies cane be implemented. Other areas of concern include: • On discussion with some staff they were not aware of a resident being barrier nursed due to infection and the manager had stated that this was the case. • Call bells were not consistently available to residents being nursed in bed so that they could summon assistance. • Tests of resident’s urine had found some problems, but there was no evidence of follow up. • Some bed rails did not appear of a suitable height where pressurerelieving equipment was in use. • Concerns were also raised about urinary catheterisation with some residents. Whilst the SOFI observation was undertaken there were noted to be some positive interactions and action taken by staff e.g. one resident was choking on her drink and the carer promptly sought help from the home manager. Another resident looked very ill in his chair so staff helped him back to his room. Feedback from health professionals indicated that staff were pleasant and carried out instructions. However, there were incidents of inappropriate referrals or lack of referral when there were areas of concern. During the inspection it was noted that the manager was discussing the care of a residents with a health professional in the dining room and this raises issues in respect of confidentiality. This practice must be reviewed and action to be taken to ensure confidentiality is maintained at all times. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 18 At the last inspection it was identified that residents did not have the opportunity to have regular baths and showers. At the beginning of the inspection the manager stated that a bath rota had been drawn up and all residents were now having a bath or shower regularly. On inspection of the record it was found that the rota was dated July and only seven residents had received a bath over the period of one week. The reason for this was not explored at the inspection, but this may be linked to the bathing facilities, which are cramped and not suitable for residents with mobility problems. Also one of the bath seats was not stable and this had been identified at the last service and was still outstanding. On reviewing care plans it was noted that some residents could be aggressive at times. Care plans did not give clear instructions as to how staff should manage this aspect of care and they have not received any training in this area. In one case it was identified at a review that an incident record should be kept in respect of a residents aggressive incidents. On inspection of the managers incident book there was no evidence of this. There was reference to an incident that resulted in a referral under the adult protection procedures, which the Commission had not been informed of and some references to staff. In such cases a behaviour chart should be in use so that the behaviour is documented, what was happening before the incident plus any comments so that any triggers to behavioural outbursts could be identified and appropriate action taken. The home has some residents who do not speak English. Although some staff are able to communicate with these residents there are shifts when there are no staff on duty who can effectively communicate. There are also some staff who work as carers who do not have an adequate command of the English language and so are not able to communicate effectively with English speaking residents and staff. This could result in residents needs not being identified and acted upon appropriately. Feedback was varied with some positive comments such as, “Staff are very good, they give me a drink when I visit”. “I had lunch on Christmas day here and I stayed overnight when the weather was bad”. Other comments indicated that some staff, particularly night staff, lacked empathy and understanding. One visitor said that the staff always treat residents with respect and staff always ensure that the lower half of people’s bodies are covered when using the hoist in the lounge to maintain their dignity. The medication was stored in medication trolleys, which were kept in a locked room. New cupboards had been fitted in the medication room and an extra trolley provided, which were observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 19 only, so they were able to check the prescribed medication against the MAR chart when it entered the home. However, there were no copies of prescriptions for medication that is prescribed at other times. Staff must ensure they retain copies of all prescriptions to ensure a robust procedure. One member of staff was responsible to receiving and checking medication into the home and it was recommended that two members of staff should undertake the procedure. Medication management was found to be of a good standard and audits were correct of the medication sampled, so ensuring residents receive medication prescribed. On touring the home it was noted that some creams had been opened and not dated, so ensuring they were safe for use and discarded within specified timescales. Daily recordings of the medication fridge temperature were undertaken to ensure that medication was stored at the temperature required to remain within the product licence of the drug. There is a telephone in the reception area and a hand held set is available for residents when privacy is required. Staff were noted to respect residents privacy knocking on doors before entering. Generally residents were well presented, but on the second day of inspection it was noted that a resident was wearing a stained top. Feedback from other sources indicted that there were some concerns about the laundry as resident’s clothes go missing or other resident’s clothes are worn and at times clothes were not clean. In one residents file it was noted that he liked to wear a moustache, but at inspection he did not have one. It was stated that staff had shaved it to make him look tidy and he was unable to make comments about his care. Staff need to be aware of residents preferences and ensure they are upheld, so that residents dignity and choices form part of their care. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 20 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): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality, quantity and choice of food are not adequate or suitable to meet resident’s needs and ensure they receive an adequate nutritious intake. There are no rigid routines and visitors can visit at time that suits them enabling residents to maintain contact with them. There is a lack of activities both inside and outside the home, so residents are not adequately stimulated. EVIDENCE: Visiting is flexible enabling relatives to visit at a time that suits them and residents to maintain contact with them. Visitors confirmed this and stated “They give me a drink when I visit”, “I had lunch on Christmas day here and I stayed overnight when the weather was bad”. Residents are able to bring personal items of furnishings etc. into the home in order to personalise their rooms and make them more homely. At the time of inspection Visitors were made to feel welcome. Staff asked a visitor if she would like a drink and chatting about how her husband was. Residents were noticeable happier when visitors were present and when staff were interacting with them, smiling chatting etc. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 21 The information provided prior to the inspection indicated that an activities coordinator was employed on a full time basis. At the time of inspection the activities co-ordinator was seen throughout the course of the day, but there was no evidence of any activities, with the exception of a visit from a person who undertook a session of music to movement. Daily records did not indicate any evidence of activities and on discussion with he activities co-coordinator they were not able to produce any records to demonstrate that activities had occurred. The manager had stated that the activities co-ordinate was involved in co-ordinating some training, as there was no deputy manager at present they were assisting her. On discussion with the activities co-ordinator she stated she arrives at 7am and checks bedrooms and residents to see they are well dressed, helps with breakfast and undertakes activities. She stated she supervised carers; making sure the residents were all right and if they wanted anything they would ask her. She takes residents out shopping, escorts them to hospital or health checks and she undertakes shopping for residents who are unable to go out e.g. buying toiletries etc. She helps with housekeeping, orders stocks of incontinent pads, aprons, gloves mattresses etc. On inspection of resident’s financial records it was noted that she had been taken a resident out shopping and they had to pay £21 for the services of the activities co-ordinator. The regulations require that residents receive/undertake activities both inside and outside the home as part of meeting their needs. Therefore, this practice should be reviewed. On discussion with some residents they stated they did get bored and would like to go out. Due to the many other roles of the person who is a designated activities co-ordinator, this area should be reviewed, as it appears that there were very few activities taking place and residents are not receiving adequate stimulation. The home employs separate catering staff who provide three full meals per day. There is a four-week rotating menu, which has been updated since the last inspection and provides a choice at meal times. There is a vegetarian option daily and an Afro Caribbean option, which is offered three times a week. It was stated that residents were consulted about choices on the day prior to serving the meal, but on discussion with some residents they stated that choices were only offered sometimes. Records of food taken by residents were still not adequate. After the last inspection the manager arranged for all residents food intake to be recorded for one week in detail and since then records were available for the evening meal some days and lunchtime only other days. The record of food served to residents must include all meals each day and all residents must be given a choice at all meals. A hot trolley had been purchased and was being used at lunchtime only, but on the day of the inspection there was a hot option in the evening and the trolley was not in use. Feedback about the meals were varied some comments indicated people were satisfied and other comments included “sometimes the Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 22 food is hot”, “food could be better, it is like bullets”, “fish fingers are empty”, “there is not much butter or ham on the sandwiches”, “don’t get enough to eat”. A complaint was received following the inspection that included concerns about the quality and quantity of food provided. This has been forwarded to the proprietor to investigate and a response is required within seven days. There are a number of residents who require a soft/liquidised diet and need assistance with feeding by staff. They were provided with assistance by staff appropriately. However, it was noted that two of the residents were given solid food items to eat at times. This does raise the question as to what the appropriate consistency of their diet should be. This will need to be reviewed to ensure residents receive a suitable diet to meet their needs and reduce any risks to them. During inspection it was noted that staff got residents up to the dining room about 30 minutes before the meal was served. Meals were presented satisfactorily and staff assisted residents with their meals in a respectful manner, with exception of a carer who told a resident he was doing really well with his meal. She was trying to encourage him but sounded patronising by saying “ good boy, good man! A SOFI observation was undertaken over a two-hour period, which included lunch. It was found that for the majority of the time was in a positive state of being (especially when visitors came, when they were having their lunch and when staff were talking to them). The vast majority of staff interactions were good. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 23 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): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems in the home for dealing with complaints are not robust and do not provide residents or their representatives with confidence that their views are listened to or acted upon. Staff require training in respect of the adult protection procedures to ensure residents are safeguarded effectively. EVIDENCE: The homes complaint procedure was on display in reception area. However, there were no details of this in the service user guide and the details in the contract of residence states that if it was felt that the request or complaint had not been satisfactorily dealt with then the matter may be referred to the Registration Authority and provided and address in Newcastle. This needs to be amended to advise residents or their representatives of their right to raise complaints with the Commission at any stage and provide the local address and telephone number. A comment and suggestion book was available in the reception area. A record of complaints was retained and there was only a record of one complaint that had been raised prior to the last inspection. Over the past year there have been eight referrals under the adult protection procedures, some of which have been made by the home and some by other professionals. When the home Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 24 made one referral to Social Services the Commission was not informed and it was only identified at the time of inspecting records at the home. As a result of the concerns raised contracting with the home has been suspended and no new residents were being admitted to the home. On discussion with staff they had some insight into the safeguarding procedures, but it was not in sufficient depth to ensure residents were fully protected. Inspection of a sample of staff records indicted that four out of ten staff had received training this area. This training will need to be cascaded to all staff to ensure robust procedures are in place and residents are safeguarded. Concerns were raised before the inspection about aspects in relation to laundry, staffing levels and staff use a of resident’s bedroom, which had been brought up with the staff in the home by the complainant and the social worker. There was no record of this and on discussion with the management team they denied all knowledge. However, the inspector has been informed that these concerns were definitely raised with the management prior to the inspection. At the last inspection there was a defensive attitude towards complaints. The action plan from the home stated that all staff were aware of the complaints procedure and any suggestions or comments would be taken seriously and records retained with an investigation by the operational manager. However, this does not appear to be happening in practice and the system must be reviewed to ensure it is robust and residents safeguarded. Since the inspection an anonymous complaint has been received by the Commission stating concerns about the management of the home, poor quality of food and the lack of bathing due to poor facilities. A letter has been forwarded to the proprietor asking them to investigate these issues and provide a response to the Commission within seven days. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 25 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): 20, 21,23,24,25,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There have been some improvements in the environment and décor, so improving the home for residents. Further work is required especially in relation to the bathing facilities, so residents are able to have a bath or shower. EVIDENCE: On arrival at the home it was noted that the exterior of the building required decorating and a number of window frames needed replacing, as they were damaged and the structural integrity was compromised. In order to gain access through the front door there are a number of steps. The home will need to provide suitable access e.g. ramped in order to meet resident’s needs who use wheelchairs and also the requirements of the Disability Discrimination Act. At the time of the inspection the proprietor provided some information about a portable ramp to the inspectors and they were advised to seek advise Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 26 from a qualified specialist. The garden to the rear of the property has had some work undertaken since the last inspection to clear the rubbish, mow the lawns and provide paving, so enabling access to residents. There is still one area to the rear of the garden that needs clearing up and the activities co-ordinator stated they were considering an area for planting, which will be very positive for residents. At the time of inspection one resident was walking around the newly paved area and some residents were sitting on the patio area. The manager had identified a risk with the level of the wall from the patio area to the main garden, as the house is at a higher level than the garden. This area still needs to be addressed. Whilst touring the garden area it was noted that the clinical waste bins were not locked, so increasing the risk to residents. There is a large imposing reception area on entering the home. There is one large lounge that leads into the dining room on the ground floor and a further two small lounges to the rear of the building and they have been re-decorated. However, one of the lounges is poorly arranged as resident’s chairs are facing the wall, there is little stimulation, little room for movement and arrangements for staff observation are poor. The dining room and lounges were not measured, but do not appear to provide sufficient space for all residents. Previously it was stated that there were plans to increase the communal space and a conservatory was to be built, but the Commission have not received any plans to date. There are sixteen single rooms and eight double rooms of which seven have en-suite facilities, but some of the en-suite facilities are not suitable for use by residents with mobility problems and some did not have a call bell to enable residents to call for assistance when required. One of the double rooms is very small and is not suitable for two residents plus equipment etc. The home has been advised that this will need to become a single room. Locks had been provided to resident’s doors enabling them to be locked, so enhancing privacy. Some residents did not have a lockable facility, which needs to be addressed for the storage of valuables and medication where required. All residents should be consulted about keys and where a key is not given a record retained in their file detailing why and be supported by a risk assessment. On inspection of a sample of double rooms it was noted that some of the screening was not sufficient in some bedrooms to promote privacy and dignity. Work was in progress to provide two double electrical sockets in bedrooms to enable the safe use of electrical equipment. Some bedside lights were not working and in other cases lights were not accessible from the bed and it is hoped that this will be addressed with the extra electrical sockets that are being provided. Some bedrooms had been re-decorated and vanity visits replaced, but there are still a number that require re-decoration to enhance the environment for residents. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 27 All areas are individually and naturally ventilated although some windows are difficult to access. Many of the radiators are covered with guards, but some of the radiator controls in resident’s rooms could not be adjusted to enable to temperature to be adjusted to suit individuals. It was noted that there were heaters in at least two rooms and it was stated that it did get cold at times, although the temperature was satisfactory on the day of inspection. Also on discussion with residents some found the lighting was not adequate and it was stated that they had bought a light or a heater. Some corridors appeared rather dim, as there were no external windows. The management of the home must ensure they provide suitable lighting and heating to all residents to meet their needs. There are a number of toilets and bathrooms in the home and signs have been placed on doors now to try and make them more recognisable and locks have been fitted to enhance privacy. Assisted bathing facilities are available on the ground and middle floor, however space is limited in the assisted bathing facilities and impacts on the privacy and dignity of residents, but also has implications for correct manual handling procedures. The proprietor will need to consider replacing these with more suitable facilities such as a flat floor shower. It was also noted that the bath seat in bathroom 113 was damaged and the bath in a ground floor bathroom was damaged. The bathroom on the first floor has a bath hoist, which was not stable on the floor and needs to be secured to ensure it is safe for use by residents. Also it was noted that the flow of water from some taps was poor and this will need to be addressed Some aspects in respect of infection control were poorly managed e.g. there was no liquid soap in some areas for staff hand washing, there is only one sluicing disinfector on the ground floor (which has now been repaired) but the first and second floor do not have a sluicing disinfector. Each floor should have a sluicing disinfector and racking to store commode pots etc. Currently shelves are available and these are not considered good practice. The home was generally clean and odour free. Work is currently under progress in the laundry area and the sluice sink has been removed and replaced with a hand washing sink to ensure adequate infection control procedures. It was stated that procedures had changed in respect of the laundry, but issues were still being raised about residents clothes going missing, clothes not being washed properly and residents wearing other peoples clothing. A further review of this area will need to be undertaken and action taken to ensure residents clothing is washed properly and returned to them. . Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 28 The kitchen is situated on the ground floor and there were dedicated catering staff. Fridge, freezer and hot food temperatures were being recorded regularly. Issues that had been raised by the environmental health officer at the last visit had been addressed, so enhancing hygiene standards. At the time of inspection the following areas were noted that need to be addressed to ensure adequate hygiene standards in the kitchen; • The kitchen door was open as there was not adequate ventilation. • Sauces and food items had been opened and not dated. • Some crockery was chipped. COSHH data sheets were available in the kitchen, but no risk assessments had been completed. Also kitchen staff need to carry out Hazeps analysis for food preparation. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Minimum staffing levels are maintained to meet residents needs. Further staff training is required to ensure staff have the necessary knowledge and skills to meet residents needs effectively. EVIDENCE: There is a manager in post who works five days per week of which three/four are supernumerary. At the time of inspection staffing levels were maintained at minimum levels to meet residents needs. It was stated there are usually two nurses and four carers on duty in the morning, one nurse and four carers in the evening and one nurse and three carers overnight. Staff files were not inspected at this visit, but at the last inspection they were found to be satisfactory with the exception of one new member of staff where a Criminal Record Bureau check had not been obtained prior to commencing employment. The information provided before the inspection stated that staff had an individual training and development plan. However, on inspection there was no plan in place and the manager stated she was just drawing up a training matrix. There was an induction programme for new staff, which had been developed further to provide newly appointed staff with the knowledge they Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 30 require to work in the home initially. It was stated that the senior carers were responsible for providing a large part of the training. On discussion with a senior carer she was unable to demonstrate an adequate knowledge in some of the areas. This was concerning as they will not be able to train new staff effectively if they do not have an adequate knowledge themselves. When this was discussed with the management team it was stated they hoped to recruit a new deputy manager and they would be responsible for the training. The information provided prior to the inspection indicated that less than 50 of care staff had completed NVQ level 2 training in care. This training is required to ensure staff have the relevant skills and knowledge to meet residents needs. The manager stated that further staff are undertaking the training in the coming year and the aim is for all care staff to be trained to NVQ level 2 by the end of 2008. On inspection of a sample of training records it was found that some staff had undertaken a range of training, whilst other had only completed one or two short courses and some of the training had not been updated. Records indicated that some staff had not completed the basic core training in fire prevention, infection control, basic food hygiene and moving and handling. The manager stated training in respect of health and safety, food hygiene and first aid had been competed recently and they were waiting for their certificates. On discussion with some staff they were not fully aware of the fire procedure and this puts residents at risk in the event of a fire. The manager stated she had completed the manual handling training course and she had trained all staff in the first part of manual handling. However, during the inspection some poor practices were still noted. Systems must be put in place to ensure all staff complete the training, nurses monitor practices and action taken where staff do not follow the correct procedures. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 31 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): 31,32,33,35,36,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management systems have been developed. These need to be fully implemented and acted upon in order to demonstrate robust management and leadership to ensure residents are safe in the home at all times. EVIDENCE: There is a registered manager in post and she stated she had completed the Registered Managers Award. The information provided indicated that regular staff meetings had occurred, but on inspection they had only occurred intermittently and at times some of them were emergency meetings. There had been one meeting with relatives when she first took up post and another one had been arranged for the following week. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 32 The manager has recently commenced formal supervision with staff and records were inspected. They were found to be lacking in detail and did not indicate aims and objectives or how staff were to be supported in the home. They tended to concentrate on outside training in respect of development. This area needs to be developed further to ensure all staff are adequately supported and supervised. At the previous inspection issues were raised about lack of teamwork and the changes in the home that some staff were not happy with. The information provided stated the issues had been addressed, morale had improved and staff now felt they were listened to and valued. Following the inspection an anonymous complaint was received by the Commission stating the manager argued with staff, they were afraid of her and she did not listen to them when concerns were raised. This information has been passed to the proprietor for investigation and a response is required within seven days. There is a quality assurance system and meetings with the management team. The manager stated she had sent out questionnaires to relatives and they would be discussed at the meeting. These were not seen at inspection and there was no evidence of feedback from other stakeholders such as staff, visiting professionals, residents etc and there was no evidence of an action plan to indicate developments for residents in order to demonstrate a cycle of continuous improvement. This area remains unchanged from previous inspections. The proprietor had written some reports in respect of the conduct of the home and forwarded them to the Commission, as required under the regulations. The accountant, who works in the home, holds money and bank book on behalf of one resident. On inspection there was no record or receipt for the bankbook. Records were maintained of money spent by the resident. However, it was noted that they had been charged for the services of the activities co-ordinator to go shopping. This practice should be reviewed as meeting residents personal and social needs is part of the regulations and the activities co-coordinator role should include activities in house and also outside for shopping trips etc. The money could not be audited as it is held in petty cash. All records were computerised and no signatures were available for transactions. The home buys toiletries in bulk and then they are charged to residents when they require them, but the cost does not reflect the actual cost of the items. The accountant previously held money for some other residents and at the last inspection stated the responsibility had been passed back to the Local Authority, but he still held some money in the homes bank account belonging Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 33 to residents. This money had been sent to the local Authority just prior to this inspection. The records in respect of maintenance and servicing of equipment etc were inspected and a number of areas had been addressed since the last inspection, so that health and safety standards were being met. Areas that still require attention include; • • The bath seat had been serviced and issues had been identified in respect of inadequate fixing to the floor. The in house checks of hot water temperatures indicated that temperatures varied from 39 degrees to 49.2 degrees. Hot water at outlets accessible to residents should be maintained at 43 degrees centigrade. Risk assessments in respect of chemicals needs to be undertaken, the fire risk assessment needs to be developed further and some of the environmental risk assessment reviewed, as they were completed in April 2006. There was no evidence of servicing of the call bell system, laundry equipment and pressure relieving mattresses. • • The information provided prior to the inspection indicated that some policies and procedures were not in place for clinical aspects of care and other areas such as fire safety, first aid, food safety and nutrition etc. It was stated that a member of the management team was to address this issue on return from leave. Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 34 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 2 1 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 1 1 1 2 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X 2 1 2 2 Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 35 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 5 Requirement A contract of residence must be provided to all residents and their representatives to provide them with information about the terms and conditions of their stay in the home. Timescale of 30/4/07 not met. All staff must receive training in caring for people with dementia commensurate with their position in the home to ensure they have the appropriate skills and knowledge to care for residents. Training has commenced by some staff. Timescale of 30/10/05 not met. Residents who are not within the homes category of registration must not be admitted to the home without first speaking to the Commission. This is to ensure residents needs can be met on entering the home. All care plans must include comprehensive assessment/risk assessments and include consultation with relevant others DS0000024813.V340120.R02.S.doc Timescale for action 15/10/07 2. OP4 12(1) 18(1) 30/11/07 3. OP4 CSA 30/08/07 4. OP7 1518(1) 30/09/07 Abbeydale Nursing Home Version 5.2 Page 36 to ensure residents full needs are identified. The plan of care must outline in detail the action required by staff to meet residents needs and must include all area of need. The plan of care must be reviewed monthly and updated where there are any changes. Timescale of 30/8/05,30/5/07 not met. Training should be given in the care planning system where required. Timescale of 30/7/06,30/5/07 not met. 5. OP8 12(1) 37 All incidents or unexplained bruising must be reported to the resident’s social worker, the Commission and investigated to determine the cause and ensure appropriate action is taken to prevent re-occurrences. Neurological observations must be undertaken on any residents who sustain a head injury to monitor their condition, observe for any side effects and take appropriate action where necessary Systems must be in place to ensure staff use the correct manual handling procedures and senior staff monitor this. Where this is not occurring it must be clearly documented in the records indicating the action taken. Timescale of 15/5/06,30/3/06 not met. All residents who requiring moving in bed have an individual slide sheet/sling that is suitable for their needs especially where it is identified that they have an infection. DS0000024813.V340120.R02.S.doc 30/08/07 6. OP8 12(1) 30/08/07 7. OP8 12(1) 15/09/07 Abbeydale Nursing Home Version 5.2 Page 37 8 OP8 12(1) 9 OP8 12(1) 13(1) 10 OP8 12(1) 11 OP8 18(1) Timescale of 20/10/06,30/3/07 not met. An audit must be undertaken of all equipment recommended by the tissue viability nurse and if there are any outstanding areas they must be addressed in order to meet residents needs and prevent pressure sores. There must be a more proactive approach to care with regular monitoring, early identification of concerns and appropriate referral to health professionals to ensure residents health care needs are met. Timescale of 30/3/07 not met. A review of residents who are having puree diets should be undertaken to determine resident’s needs and action where necessary to ensure they receive the appropriate diet and are not put at risk. Staff must be provided with training in respect of handling aggression to ensure residents and staff are safe. The meals must be reviewed and action taken to ensure residents receive a nutritious, wholesome and varied diet that meets their needs and preferences and includes a range of fresh produce. Where residents are identified to be nutritional at risk appropriate action must be taken to ensure their well being. The record of food must be comprehensive for each meal taken by residents, so the person inspecting can determine if the residents are receiving a nutritious diet. Timescale of 20/10/06,30/3/07 DS0000024813.V340120.R02.S.doc 30/09/07 30/08/07 15/09/07 15/10/07 12 OP15 OP8 16(2)(i) 12(1) 01/09/07 13 OP15 17(2) 10/09/07 Abbeydale Nursing Home Version 5.2 Page 38 not met. 14 OP16 22 There must be a robust system for all complaints and concerns. They must be recorded appropriately, investigated and action taken to address any shortcomings with records maintained. This is to ensure all concerns are dealt with in a positive and open manner, provide confidence to residents and lead to improvements in the home. Timescale of 30/3/07 not met. All staff must receive training in respect of adult abuse; the procedures for responding to any allegations including the whistle blowing procedure to ensure residents are safeguarded effectively. Timescale 30/3/07 not met. An audit of the exterior of the home must be undertaken damaged windows replaced plus cladding and re-decorate where necessary. Timescale of 30/10/05 not met. Ensure suitable hygiene standards in the kitchen; • Provide suitable ventilation • Replace damaged crockery • Ensure all sauces and food items are dated when opened, stored correctly and used within timescales. Suitable ramped access must be provided to the front of the building in order to meet residents needs who are wheelchair users and DDA Timescale of 30/8/06, 30/6/07 not met. DS0000024813.V340120.R02.S.doc 10/09/07 15 OP18 13(6) 30/09/07 16. OP19 23(2)(b) 30/10/07 17 OP19 16(2)(j) 30/09/07 19. OP19 23(2)(n) DDA 30/10/07 Abbeydale Nursing Home Version 5.2 Page 39 20. OP19 13(3) 21 OP20 23(2)(g) 22. OP21 23(2)(j) (n) 23 24. OP22 OP23 23(2)(n) 23(2)(e) (f) 25. OP25 23(2)(p) The registered person must ensure clinical waste bins are locked when not in use to ensure adequate infection control procedures. Timescale of 30/3/07 not met. Plans with timescales for extension to the communal space should be forwarded to the Commission to ensure there is adequate communal space for the use of residents. Timescales since May 2004 not met. A review of the bathing facilities must be undertaken and action taken to provide suitable assisted bathing facilities in all areas that residents reside. This is to ensure residents can bathe with assistance from staff and their privacy and dignity is maintained. Timescale of 30/7/06, 30/6/07 not met. A call bell must be available in all en-suite areas so residents can summon assistance if required. Information must be provided as to when the small double room will revert to a single room to ensure adequate bedroom space for the resident using the room. Timescale of 30/7/05,30/7/06, 30/3/07 not met. All areas of the home must be kept warm at all times to meet resident’s needs. There must be an adequate flow of water from all water outlets. Ensure there is adequate lighting in all areas of the home to reduce the risk of any accidents. 10/09/07 30/09/07 30/12/07 30/10/07 30/09/07 30/10/07 26. OP26 13(3) A sluicing disinfector should be provided on each floor with DS0000024813.V340120.R02.S.doc 30/12/07 Page 40 Abbeydale Nursing Home Version 5.2 raking and hand washing facilities to ensure adequate infection control within the home. Timescale of 30/5/06 not met. 28. OP30 18(1) A review of the arrangements for induction training should be undertaken to ensure staff are provided with the appropriate knowledge to do their job when commencing employment. Timescale of 30/8/05, 30/7/06,30/3/07 not met. All staff must undertake training in respect of basic food hygiene and records must be retained in the home to ensure staff have the appropriate knowledge and practice to maintain adequate hygiene standards in the kitchen and when handling food. Timescale of 30/12/05, 30/7/06, 30/3/07 not met. All staff must undertake updated training in respect of moving and handling residents, systems must be in place to ensure good practice at all times to ensure residents safety and records must be kept in the home. Timescale of 30/12/05, 30/7/06, 30/3/07 not met. All staff must undertake training in respect of infection control and systems must be in place to reduce the risk of cross infection and. Records must be kept in the home Timescale of 30/12/05, 30/7/06, 30/3/07 not met. All staff must undertake updated training in respect of fire prevention and fire drills at least twice a year and be able to demonstrate the action to take in the event of a fire to ensure residents safety in the event of a DS0000024813.V340120.R02.S.doc 30/09/07 29. OP30 16(2)(j) 17(2) 30/10/07 30 OP30 13(5) 17(2) 30/09/07 31 OP30 13(3) 17(2) 30/10/07 32 OP30 23(4)(d) (e) 17(2) 30/09/07 Abbeydale Nursing Home Version 5.2 Page 41 33 OP32 12(5) 12(1) 34. OP34 2017(2) 35. OP38 13(4) 36. OP38 13(4) 17(2) fire. Timescale of 30/12/05, 30/7/06, 30/3/07 not met. The registered person must review and address current issues in the home and address shortfalls in team working. Timescale of 30/4/07 not met. There must be robust systems in place for dealing with resident money and valuables with receipts for all deposits and withdrawals. The registered person must undertake risk assessments in respect of chemicals, fire and environment with appropriate action plans to reduce risk. Timescale of 30/6/07 not met. Arrangements must be made for the following areas to be serviced/maintained to ensure adequate health and safety in the home. The bath seat must be fixed properly and made fit for use. • Hot water temperatures must be maintained at 43 degrees or - 1 degree. Timescale of 30/4/07 not met. • • • Service the call bell system regularly. Service pressure relieving mattresses regularly. Replace hoist that has been identified as not longer fit for use. • 30/09/07 30/09/07 30/09/07 30/09/07 Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 42 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The service user guide should include a copy of the contract and complaint procedure in inform residents and their representatives of the terms and conditions of their stay in the home. Incontinence sheets must not be used on chairs used by residents to ensure their dignity is preserved. The staff must ensure an effective continence management programme is in place. Residents should be consulted about their wishes in respect of bathing and suitable arrangements put in place to meet their needs. All residents should be offered a choice of G.P to ensure their preferences are respected. Review the arrangements for residents oral care to ensure their needs and comfort are maintained and infection prevented. All residents with chronic diseases such as diabetes, hypertension asthma, etc. should be reviewed on a regular basis by a health professional and records retained in the home. This is to ensure their health needs are met. All staff working in the home, as carers must be able to speak English effectively to ensure they can identify residents needs and requests. There should be at least one member of staff on duty at all times who can communicate with residents from minority groups. Effective behaviour monitoring should be undertaken where residents are displaying aggressive behaviour. All creams must be dated when opened and discarded within specified timescales in order to prevent the risk of infection. Copies of all prescriptions must be retained in the home to enable auditing of medication. It is recommended that two staff check medication entering the home. Suitable arrangements must be made to ensure that all details discussed about residents are confidential. Arrangements must be put in place to provide residents with a range of suitable activities both in house and DS0000024813.V340120.R02.S.doc Version 5.2 Page 43 2. OP8 3. 4 5 6 OP8 OP8 OP8 OP8 7 OP8 8 9 OP8 OP9 10 11. OP10 OP12 Abbeydale Nursing Home outside the home to meet their needs. It is recommended that the activities co-ordinator undertakes some formal training and records of activities undertaken by residents are maintained. 12 13 14 15 OP15 OP15 OP15 OP19 The hot trolley should be used at all meals where items of hot food are served to residents. Systems must be in place to ensure residents are offered a choice of food at all meal times. The practice of residents sitting in the dining room for long periods before meals are served should be reviewed. The remainder of the garden is cleared and made fit for use by residents. Suitable arrangements are made to ensure the safety of the wall on the patio area. The programme of re-decoration is completed to provide and pleasant and homely environment for residents. All residents 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 residents. All residents 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 residents receive their own clothing back that is clean and in a timely manner. At least 50 of care staff should complete NVQ level 2 in care and records kept in the home for inspection. This is to provide staff with the appropriate skills and knowledge to care for residents. It is recommended that a training matrix is developed to enable easy recognition of staff training completed and areas that need to be addressed. 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 residents. Regular planned staff meetings should be convened to assist with communication and team working. The system of formal staff supervision should be reviewed and be undertaken six times per year by a person who has undertaken training in this area. The process must cover all areas outlined in the standards, arrangements for support and how objectives and to be achieved and records must be retained in a confidential manner. DS0000024813.V340120.R02.S.doc Version 5.2 Page 44 16 17 18 19 20 21 OP23 OP24 OP25 OP25 OP26 OP28 22 23 OP30 OP33 24 25 OP32 OP36 Abbeydale Nursing Home Abbeydale Nursing Home DS0000024813.V340120.R02.S.doc Version 5.2 Page 45 Commission for Social Care Inspection West Midlands Regional Office 1st Floor Ladywood House 45-56 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.V340120.R02.S.doc Version 5.2 Page 46 - 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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