CARE HOMES FOR OLDER PEOPLE
Abbeyfield Lear House Darmonds Green West Kirby Wirral CH48 5DT Lead Inspector
Inger Moynihan Unannounced 14 September 2005 8.45 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 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 Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Abbeyfield Lear House Address Darmonds Green West Kirby Wirral CH48 5DT 0151 625 1883 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Abbeyfield Hoylake and West Kirby Limited Mrs Lesley Saunders PC Care Home 24 Category(ies) of OP Old Age - 24 registration, with number of places Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 4th November 2004 Brief Description of the Service: Lear House was first registered in 1984. The home is owned and managed by The Abbeyfield Society and provides accommodation for 24 service users in a large detached house in its own grounds. The home is close to local facilities including shops, leisure centre, library, churches, and public transport including bus and train services.The home provides single accommodation with en-suite facilities consisting of a toilet and washbasin. There is one lounge/dining room and two further lounges one on the ground floor and another on the first floor. A seating area is also provided in the former entrance hall. The home is furnished and decorated to a high standard throughout. There is a passenger lift which accesses the bedrooms on the first floor. There are four bedrooms which are accessed by four stairs. All corridors have handrails.There is a level access to the front and rear gardens. All the grounds are well maintained with mature trees, shrubs and flowerbeds. The garden room opens directly on to the garden where there is an ornamental fishpond, benches and other garden furniture. There is parking space for twenty cars within the grounds of the home. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 3 hours and was the statutory unannounced inspection for 2005/2006. A partial tour of the premises took place and staff service users records were inspected. Three staff and four service users were spoken to during the inspection. What the service does well:
Service users physical and mental health is maintained through regular contact with healthcare professionals and the support of care staff. Thorough medication administration procedures are in place to ensure service users good health and well being. The routines within the home are flexible which gives service users the opportunity to exercise a choice in how they spend their day. A range of social activities are provided which contributes to creating a lively and interesting environment. A varied and nutritious diet is provided which ensures service users good health and interest. A complaint procedure is in place to ensure service users views are taken into account with regard to the care provided. The service users spoken to stated they were completely satisfied with the standard of care they received and commented on the kind and caring nature of the staff team. An adult protection procedure is also in place to ensure service users safety and welfare. The standard of decoration throughout the home remains very high and provides a comfortable and pleasant environment for the service users to live. The required staffing levels and skill mix are provided to meet service users assessed needs. Staff are provided with a range of appropriate training to ensure the care they provide is in line with service users needs. There are clear lines of management and accountability within the home which is run for the best interest of service users. Effective quality assurance systems are in place to ensure the high standards of care provided at Lear House are maintained. The health, safety and welfare of the service users is well promoted throughout the home.
Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 6 The service users spoke well of staff team and said they were always available for support. They said they enjoyed the meals provided and confirmed a choice is always available. Service users spoken to confirmed the routines in the home are flexible which they preferred. Staff said they felt well supported by the registered manager and senior staff who are always available for advice when required. The staff spoken to had a very positive attitude towards their work and felt they worked well as a team. The staff group is consistent which is a positive aspect of the home as this provides consistency in the care to service users. What has improved since the last inspection? 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. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users’ care needs are assessed before they move into the home to ensure the registered manager and staff team can provide the required care. EVIDENCE: An assessment of service users individual care needs is carried out prior to any service user being admitted into the home. This ensures the registered manager and staff team are able to meet the service users’ specific care requirements. Service users confirmed their care needs were met in every way. The service users spoken to stated they were completely satisfied with the standard of care they received and commented on the kind and caring nature of the staff team. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 and 9 Service users physical and mental health is maintained through regular contact with healthcare professionals and the support of care staff. Thorough medication administration procedures are in place to ensure service users good health and well being. EVIDENCE: Service users physical and mental health care needs are met through the support of a range of healthcare professionals, staff being provided with appropriate training, the provision of a varied and balanced diet and the support of the care staff. Service users confirmed they had access to the health care professionals they required and all spoke highly of the registered manager and staff team. A daily record of service users welfare is kept to help staff monitor their general welfare. This is further supported by a system whereby staff spend time each day discussing any issues or concerns that may have arisen over the past 24 hours. All of these factors contribute to providing a safe environment for service users to live. The registered person receives regular bulletins from the Medical Devices Agency which gives advice and guidance on the use of specialist equipment used in care homes.
Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 10 Good facilities and systems are in place for the storage, recording and administration of medication which ensures service users medical needs are met. All staff who administer medication have been provided with appropriate training in May of this year. One service user takes responsibility for their own medication which promotes and maintains their independence. While a risk assessment had been carried out to ensure this service user was safe to take on this responsibility, more detailed information does need to be recorded to demonstrate all aspects of care assessed. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The routines within the home are flexible which gives service users the opportunity to exercise a choice in how they spend their day. A range of social activities are provided and contribute to creating a lively and interesting environment for the service users to live. A varied and nutritious diet is provided which ensures service users good health and interest. EVIDENCE: The service user spoken to during the inspection confirmed the routines within the home are flexible and they could go about their day as they wished. This is a positive aspect of the home and ensure service users can exercise choice and independence. A range of social activities are provided which the service users confirmed they were free to participate in if they wish. A number of service users confirmed the activities were appropriate and enjoyable. During discussion they confirmed their friends and relatives could visit the home at any time. A varied and balanced diet is provided to ensure service users interest and good health. Service users medical needs are catered for in the menu planning. All of the service users commented on how much they enjoyed the food with one service user stating the food is lovely and I am always given an alternative if I do not like what is offered that day.
Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 A complaint procedure is in place to ensure service users views are taken into account with regard to the care provided. An adult protection procedure is in place to ensure service users safety and welfare. EVIDENCE: A staff and service user complaints procedure is in place. This procedure is in the process of being reviewed to ensure it is up to date and in line with current good practice. The service users spoken to during the inspection had no complaints to make about the standard of care they received. They spoke highly of the registered manager and staff team and said they were completely satisfied with the care provided. Their comments included ‘the staff are courteous and efficient, I have no complaints to make about the care. If i did want to make a complaint I would contact Mrs Saunders, the registered manager. This was further supported by another service user who said I am very content with the service I receive, living at Lear House is like living at home. Neither the CSCI nor the registered manager have received any complaints about the standard of care provided at Lear House. Staff spoken to confirmed they had completed training on the protection of vulnerable adults from abuse. And they demonstrated they were clear on the action they would take in the event of them suspecting or knowing an incident of abuse had taken place. Last year the organisation Action on Elder Abuse set up a telephone line were service users and staff could report incidents of abuse anonymously. It is
Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 13 recommended that for service users further protection, this telephone number is made available to both staff and service users to enable them to raise any concerns. This telephone number can be found on the Action on Elder Abuse website. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The standard of decoration throughout the home remains very high and provides a comfortable and pleasant environment for the service users to live. EVIDENCE: The standard of the décor throughout the home remains very high and a planned programme of maintenance is in place. There are landscaped mature gardens surrounding the home. Handrails and sloped paths are provided to assist service users with their mobility and to ensure their safety. For security purposes, a CCTV camera has been installed at the front entrance along with secure gates. There are sufficient toilet and bathing facilities for the number of service users living at the home and all rooms have en-suite facilities. The home has two small lounges and lounge/dining room. The dining room can accommodate all the service users in one sitting, although this area is rather cramped at lunchtime. The home has a no smoking policy in all communal areas. Service users may smoke in their own room although this is subject to a risk assessment to ensure their safety.
Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 15 The home has various aids and adaptations to promote service user independence and ensure a safe environment is provided. Facilities are in place throughout the home to ensure service users comfort. Since the last inspection the registered manager has arranged for a sensory garden to be built at the front of the home. This is an extremely pleasant area for the service users to sit and a large umbrella is provided to protect the service users from the sun. The service users spoken to confirmed they had access to this area and enjoyed sitting with the staff when the weather was good. Systems are in place to ensure the prevention of cross infection and to ensure a safe environment is maintained. It is clear the domestic staff are working hard to maintain high standards of cleanliness throughout the home. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The required staffing levels and skill mix are provided to meet service users assessed needs. Staff are provided with a range of appropriate training to ensure they are suitably qualified and competent to care for vulnerable adults. EVIDENCE: The staff rota indicated staff are evenly deployed across the week and that the required staffing levels, as agreed by the Registering Authority are provided. Examination of staff files for the person most recently employed indicated that a Criminal Record Bureau check had been completed and all other checks had been carried out. this is in line with good practice and ensures service users safety and welfare. The staff spoken to confirmed they had completed a range of training relating to the care of older people. This is a positive aspect of the home and ensures the service users are being cared for in accordance with their particular needs and current good practice. More than 50 of the staff team are qualified to NVQ level 2 and a number of staff are in the process of completing this qualification. In addition to this formal training, the registered manager also carries out informal in-house briefings on issues relating to service users particular health requirements. The staff spoken to had a positive attitude towards their work with one member of staff stating I love my work and I feel we all work well as a team. This is a positive aspect of the home and contributes to good standards of care being provided. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 17 The staff group is stable. Again this is a positive aspect of the home as this provides consistency in the care provided and enables positive working relationships to develop. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38 There are clear lines of management and accountability within the home which is run for the best interest of service users. Effective quality assurance systems are in place to ensure the high standards of care provided at Lear House are maintained. The health, safety and welfare of the service users is well promoted throughout the home. EVIDENCE: The registered manager demonstrated she was aware of her responsibilities with regard to the management of the home, supervision of staff and the care of service users. Through discussion she demonstrated her commitment to supporting the staff within their role and demonstrated an open and positive style of management. Effective quality assurance systems are in place to ensure high standards of care are maintained. The registered person reports to the CSCI each month on the standard of care provided (this is in line with the Care Homes Regulations 2001) and the society and house chairperson visit the home to
Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 19 speak to the service users and staff about the standard of care provided. CSCI leaflets have been left at the home to enable service users to comment to the Commission about the standard of care they receive. The views of the standard of care provided at Lear House will be obtained from a range of health care professionals that visit the home following the inspection. All comments will be returned to the registered provider who will be asked to deal with any issues that arise. Safe working practices are promoted throughout the home and staff have completed appropriate training to ensure service user safety. Regular fire safety checks are carried out on all equipment and staff have been provided with regular fire safety training. To further promote service users health and safety, the registered person is advised to keep up to date with the information provided on the Health and Safety Executive website. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4
COMPLAINTS AND PROTECTION 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 x 4 x x x x 4 Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. Refer to Standard 18 Good Practice Recommendations It is recommended that the registered person makes available to both staff and service users the telephone number of Action on Elder Abuse. This will enable them to report any incidents of abuse anonymously. Abbeyfield Lear House F52 F02 S0000018850 Abbeyfield Lear V236396 070905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 3rd Floor 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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