CARE HOMES FOR OLDER PEOPLE
Abbeyfield House Abbeyfield House Union Street Low Moor Clitheroe Lancashire BB7 2NH Lead Inspector
Mrs Christine Marshall Unannounced Inspection 14th December 2006 10:00 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 Abbeyfield House DS0000009529.V320114.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. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abbeyfield House Address Abbeyfield House Union Street Low Moor Clitheroe Lancashire BB7 2NH 01200 442550 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) The Abbeyfield Lancashire Extra Care Society Limited Mrs Georgina Sandra Marsden Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: Abbeyfield House is part of The Abbeyfield Lancashire Extra Care Society Limited, which is a voluntary organisation. The home can accommodate 29 older people, aged 65 years and over. It is a purpose built, detached property set in its own grounds and offers 27 single and 1 shared bedroom, all of which have en-suite facilities. There are 2 lounges and a dining room on the ground floor and a quiet lounge on the first floor. There is a paved patio area and garden to the rear of the home with a small car park to the side. The home is non-smoking. Abbeyfield House is located close to a bus route, with access to Clitheroe town centre. The responsible individual for the home is Mr Norman Green and the registered manager is Mrs Georgina Marsden. At the time of this visit, (14/12/06) the information given to the commission showed that the fees for care at the home were £353 per week, with added expenses for hairdressing, chiropody and newspapers. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection process of Abbeyfield included a site visit to the home which was completed in one full day, and unannounced, which means that the manager, staff and residents did not know it was taking place until the inspector arrived. Time was spent sitting and talking with people who use the service, and observing the day-to-day routines of the home and care staff, as they provided support. A tour of the home included looking at bedrooms, lounges and dining areas, toilets and bathrooms. This was to assess whether the home provided a comfortable, homely environment for the enjoyment of everyone, and to ensure the residents’ safety. Comment cards were sent to the home for residents and relatives to fill in; however none were returned. A pre-inspection questionnaire was completed by the registered manager, and forwarded to the commission before the inspection visit; this offered good information about the home and its policies, and enabled the commission to assess and plan the inspection visit. Nineteen residents were spoken with and their comments included – “The attendants (carers) are lovely.” “I wouldn’t want to be anywhere else.” “The food is good, very varied. If I ask for anything different, then they give it to me.” There were no visiting relatives available during the visit. Discussions took place with the registered manager, and members of the care staff. Administration records were also looked at. Everyone at the home was friendly, welcoming and co-operative throughout the visit. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Recruitment files now contain all records that are required by the Care Homes Regulations. This means that the residents are protected through a robust recruitment procedure, where staff are vetted and checked before they begin to work at the home. Pre-admission assessments now include all aspects of daily living activities under identified headings. This makes sure that the resident’s needs and strengths are looked at before they enter the home, and so that it can be
Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 7 decided whether or not the home can provide the service that the resident needs. Daily records now include the time of writing the report, and so it is possible to see a clear picture of care that is given throughout the day or night. What they could do better: 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. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 8 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 Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 9 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): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home gathered good information about prospective residents, so that their needs could be met. EVIDENCE: Pre-admission assessments were looked at for three residents and these were completed extremely well; they were quite comprehensive and included all aspects of physical, social and psychological care, making sure that the prospective resident’s needs were identified, and that the home could provide the care that was needed. These assessments were done by the manager, and agreed by the resident and/or their family.
Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 10 The residents were asked if they had been visited before going into Abbeyfield and some were able to confirm that they had been assessed before entering the home. Generally all residents were assessed by the same tool, thus promoting equality of assessment and care provision. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 11 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): Standards 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs were met and people were treated with dignity and respect at this home. EVIDENCE: Care plans are written records that describe the care that is given to each resident. These were looked at and found to be informative, but some needed more regular reviews and updates. All aspects of care had been considered, including a good social history. Although this standard has been met, a recommendation has been made at the end of this report
Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 12 Many of the residents were unable to say that they knew about their care plans; others were able to confirm that they knew about them, but that they were not really interested. Health care opportunities were offered equally to all residents and there were records of GP, chiropody and physiotherapy visits. The medication system was looked at and found to be basically satisfactory. One medication sheet had been hand-written, and it was advised that when any records were handwritten, then the signature of the person who had written them should be in place, with a witness signature as well. This is to make sure that any hand written drugs instructions are recorded correctly. This will also avoid any errors and will safeguard the resident. Although this standard has been met, a recommendation has been made at the end of this report The residents were seen to be treated with respect, privacy and dignity, and there were good personal interactions between residents and carers. Each bedroom door had a lock, and the resident’s were given the option of retaining the key. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit by being supported, so as to promote the quality of their daily lives. EVIDENCE: The home offers activities such as board games, reminiscence and manicures for the residents. There are regular outings arranged and there was a good Christmas programme being put together for the residents. Religious ministers also visit the home. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 14 Residents who were able said that they sometimes preferred to just have quiet time rather than organised entertainment or activities: They also said that they had full choice of what they wanted to do in their daily routines. A number of residents said that they enjoyed having their relatives visit and that they were always welcomed by the staff at the home. The midday meal served at the home during the visit looked appetising. There was a set main course, but with a choice if preferred. There is equality of choice for every resident and there was also the same sweet choice for diabetic diets, as sweeteners are used instead of sugar. The home caters for any other preferred diets that are requested or required, for example vegetarian or diabetic food. The evening meal also offers full choices, with afternoon tea and suppers available. The residents said that the food was good and that they had plenty of choice. The mealtime was relaxed and unhurried, with the carers helping discretely when needed. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 15 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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit by being supported and protected. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and staff said that they were aware of these. There has been one allegation levelled against the home, which was investigated by the Social Services Adult Protection Team. The outcome of this investigation found the allegation to be unsubstantiated. The residents were asked if they knew about the complaints procedure and whom they would speak to if they were unhappy; each of those spoken to said that they knew about the procedure and who to speak to; however they insisted that they had no complaint to make at all.
Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 16 All staff records show that abuse awareness training had been given and staff confirmed this. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 17 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): Standards 19,20,21,22,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were provided with a comfortable environment and bedrooms were personalised. This means that residents felt at home with their belongings around them. EVIDENCE: A tour of the home showed that the general environment was more than satisfactory and furnishings were comfortable. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 18 There was equal access to all areas of the home for residents and visitors with mobility problems, in that there were wheelchair ramps and a passenger lift in place. There were aids and adaptations in place to give equal access and to help with the residents’ toilet and bathing needs. Most of the residents were able to say that they were happy with their rooms, and all the bedrooms that were visited were clean, very personalised and very comfortable. The laundry area was very clean and hygienic. Policies were in place for the prevention of any cross infection and domestic staff said that they knew about these. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents care needs were met through adequate staff provisions who were appropriately trained. EVIDENCE: The home’s equal opportunities policy was reflected in that there were male and female staff, between the age of 18 and 65 working at the home. The list of staff on duty showed that there were adequate levels of carers and domestic staff on duty. Residents who were able said that they never had to wait very long for the carers to help them and that they were happy with the levels of staff on duty. The carers and the domestic staff were very helpful and showed that there was a good mix of people in place.
Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 20 National Vocational Qualifications (NVQ) and staff training programs were in place and over 75 of carers had currently achieved the NVQ award. The staff who had completed their NVQ training had also done a unit covering Equality and Diversity issues and this means that they would be aware of how they could make sure that the residents were treated equally, and given care according to individual choice and preference. Recruitment files were satisfactory and showed that pre-employment checks were done so that the residents were protected. The home’s pre-inspection questionnaire gave good information about staff training. Staff also confirmed that they had undergone induction and training programmes. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 21 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): Standards 31,33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were supported and there were quality systems in place to make sure that they were protected. EVIDENCE: The registered manager is qualified and experienced and has been managing the home for many years. Discussions with the residents and staff showed that she was generally respected and seen around the home regularly.
Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 22 There was a quality monitoring system in place, which is Investors in People (IIP). Representatives of the Abbeyfield Society have undertaken monthly monitoring visits and it is planned that the outcomes of these visits will be summarised and posted in the home’s notice boards for the residents and their families to see. Although this standard has been met, a recommendation has been made at the end of this report Staff said that they were encouraged to be proactive in improving the quality of care that was provided at the home. The pre-inspection questionnaire provided information about residents’ financial arrangements and records that were kept at the home; also information was given that the safety certificates at the home were up-to-date, making sure that the residents were safe and secure. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 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 3 X 3 X 3 X X 3 Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP7 OP9 OP33 Good Practice Recommendations Care plans should be reviewed more regularly so that they fully reflect the care that is given to the residents. Handwritten medication records should have two signatures, to verify that the instructions are correct and thus safeguard the resident. The outcomes of the monthly monitoring visit by the representative of Abbeyfield should be summarised and posted on the notice boards for residents and their families to see. Abbeyfield House DS0000009529.V320114.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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
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