Inspection on 12/10/06 for Abbeyfield Lodge

This inspection was carried out on 12th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeyfield Lodge 13/12/05

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME ADULTS 18-65 Abbeyfield Lodge 184-186 Reading Road South Church Crookham Fleet Hampshire GU52 6AE Lead Inspector Mr Ian Craig Unannounced Inspection 12th October 2006 10:00 Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbeyfield Lodge DS0000065818.V312312.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield Lodge Address 184-186 Reading Road South Church Crookham Fleet Hampshire GU52 6AE 01189 581950 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) Truecare Holdings Limited Mr Sunil Raj Dharmabandhu Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: Abbeyfield Lodge provides personal and/or nursing care to adults with a mental disorder. There is no provision for the detention of people under the Mental Health Act 1983, although residents may be under community supervision arrangements of the Act. A Registered Mental Nurse (RMN) is on duty at all times. The home works jointly with local hospital and community psychiatric services. Placements at the home may be part of a rehabilitation programme following discharge from an acute psychiatric ward. The home is involved in multi agency planning meetings for individual residents. The facilities of the home are of a high standard. There is a computer with access to the internet and e-mail for the residents to use. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of a tour of the building, observation of residents taking part in activities, interviews with residents, discussions with staff and the acting manager. Records were also examined. A visiting social worker was also interviewed. The home’s management has been unsettled. Since the last inspection on 13/12/05 the registered manager has changed twice and the position is now vacant. The deputy manager was managing the service in an ‘acting up’ position. The findings of this inspection need to be seen in context of these management changes. The range of fees is from £315.35 to £806.82 per week. What the service does well: What has improved since the last inspection? The home continues to maintain a clean and homely environment. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 6 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 Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users needs are fully assessed in conjunction with local mental health services to ensure only those whose needs can be met are admitted to the home. EVIDENCE: Whilst the home has not admitted any service users since the last inspection, it was clear from records that the home liaised closely with local referring social services and mental health teams in assessing residents. Representatives from the home attend multi agency planning meetings on individuals entitled, Care Programme Approach (CPA). Copies of minutes from these meetings were held on individual resident’s files. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Whilst each resident has a care plan, these need to be expanded to show that social, recreational, occupational and educational needs are being addressed. Service users are able to develop and maintain their independence, although it is not clear that the home always safeguards residents. Service users are consulted on various aspects of life in the home, although this needs to be developed further. EVIDENCE: Each service user has a file containing assessments and care plans. These are subdivided into differing areas of need, and showed that mental health needs were, generally, addressed, whilst social needs were not. For several residents the “social, recreational, occupational, educational and religious needs” section was empty. Care plans showed that independence was being promoted with residents being encouraged to take responsibility for aspects of daily living in the home such as tiding their rooms. Records also showed that the home provides input from a clinical psychologist on a regular basis for each resident. Using the key Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 10 worker system, each resident has time with their allotted worker for one to one ‘counselling.’ These were well recorded. Daily running records were also recorded to a good standard demonstrating that behaviour and mood were closely monitored, and that staff responded promptly to these needs. Staff were also observed to respond to residents’ changes in mood, which was also confirmed by those residents interviewed. There was one exception to the daily running records being well maintained which related to one service user. Contradictory information was recorded regarding actions taken by the home for similar incidents. These incidents formed a pattern of behaviour that needed to be assessed and planned for, in conjunction with local mental health services. A risk assessment form had been completed for one incident but it failed to show what the risks were, and what action was being taken. For other areas where residents were exercising independence risk assessments were recorded. Residents had signed their care plans acknowledging agreement to its content. It was confirmed from typed minutes and from discussions with residents that residents’ meetings take place on a regular basis. Residents also stated that they felt able to raise any concerns with the home’s staff. There is a format for issuing survey forms to residents in order to obtain their views about the home which can be incorporated into a quality assurance system. None of these forms, however, had been completed by residents. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have opportunities to develop independence and to pursue meaningful activities both within and outside the home. The home provides a nutritious diet with a choice of food. EVIDENCE: It was clear from observations, discussions with residents, records, and notices in the home, that residents are able to develop and maintain their independence, including attendance at a variety of activities. These include sports such as badminton and swimming, art classes from a qualified artist for 5 hours a week, going to the cinema and pubs, social clubs, day centres and college courses. Residents stated how they enjoy the art classes. The home also promotes residents maintaining personal and family relationships. A notice board in the hall gives details of a therapeutic activity programme, which includes outings, computer skills, swimming and quizzes. Residents have access to two computers in the home one of which has internet facilities. The home employs an activities coordinator. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 12 A visiting social worker described how residents have not been able to have a holiday this year and a resident also stated that he would like to have a holiday. The acting manager explained that holidays will be available in the forthcoming year and that the home now has a budget for this activity. As referred to in the ‘Individual Needs and Choices’ section of the report, additional recording is needed to show that each person’s social, leisure, occupational and educational needs have been assessed and are being met. The inspector observed the serving of the midday meal. Residents were able to ask for any meal they wished, some having soup, another omelette, another boiled egg with bread. A larger evening meal is provided and again residents are able to make a choice of what to eat. Residents confirmed that the food is of a good standard and that choice is available at each meal. Menu plans and records confirmed that a nutritious diet is provided and that residents eat different meals reflecting their choice. Fresh fruit was available in the dining room. There are facilities for residents to make hot and cold drinks in the dining area and for helping themselves to snacks. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ personal and healthcare needs are met although there is an outstanding requirement for medication procedures, which has not been addressed. EVIDENCE: Residents are generally independent in personal care routines. Details of how residents are prompted and assisted in these areas are recorded in care plans. Care records also showed how mental health needs are met, including how staff support people during periods of crisis. Residents confirmed that staff are helpful and supportive. The manager explained how each resident’s health needs are met by facilitating appointments with general practitioners, dentists and opticians. Residents are encouraged to handle their own medication. This is reviewed on a regular basis and when circumstances change. Records showed that as a resident’s needs change, arrangements for medication can be adjusted to ensure that prescribed medication is taken. There is an outstanding requirement regarding the administration of ‘medication as required.’ The circumstances and symptoms requiring the use of ‘medication as required’ are Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 14 not recorded. The need for this to be recorded was further highlighted by the fact that a resident had complained to the home about the frequency of this medication being dispensed. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users views are listened to and there are procedures for ensuring the protection of vulnerable adults although this could not be confirmed regarding residents’ finances managed by the home. EVIDENCE: The service users interviewed stated that they felt able to raise any concerns they had with the home’s management. The complaints procedure is freely available in the home being displayed in a brochure and on a notice board. Where a complaint had been made, there was a clear record of the details and how the service had dealt with the matters raised. A written response was provided by the home outlining how the matter had been looked into and what the outcome was. For another concern raised by a resident, it was unclear how the home had dealt with this and what the final outcome was. This was raised with the acting manager, including reference to how the process could be improved. The home has its own policies and procedures for dealing with any suspected adult protection matters as well as a copy of the local authority procedure. Training is also provided for staff in this area. There are clear policies for dealing with any aggressive behaviour on the part of residents. This involves avoiding conflict and restraint by the use of diversion techniques. Records confirmed that staff use this approach when dealing with situations where conflict may arise. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 16 Where the home handles residents’ finances, clear records are maintained of the amounts deposited, withdrawn as well as a running balance. However, this applies to the money held in the home and not the amounts held by the company at the head office. A record of any monies held by the home or company must be maintained and available at the home. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Service users benefit from a clean, well maintained environment with a variety of facilities. The home’s physical promotes the dignity of the residents. EVIDENCE: A tour of the premises showed the home to be clean, well maintained and decorated to a good standard. Communal areas are furnished to a good standard. There is a lounge area with an adjoining dining room, which has refreshment facilities so that residents can make hot and cold drinks as well as being able to help themselves to snacks. Patio doors open onto the rear garden, which is landscaped and has good quality garden furniture. For those that smoke there is a dedicated room. In an annexe at one end of the garden there is an activities room with books, a guitar and a computer. The home has two computers for residents to use, one of which has internet and e mail access. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 18 Bedrooms are decorated to a good standard and contain numerous items of resident’s personal belongings. Toilets and bathrooms are clean, pleasantly decorated and are ‘homely.’ Residents described how they enjoy the facilities offered by the home. The inspector was able to observe residents making use of the communal facilities. The laundry is well equipped. Arrangements have been made for staff to have training in infection control. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff are provided in sufficient numbers to meet residents needs, although the staff rota did not always accurately reflect the staff who were on duty. Residents are protected by the recruitment process. Whilst staff have access to training courses individual supervision of staff has not been taking place. EVIDENCE: The staff rota generally showed the provision of sufficient care staff, although it was noted that where agency staff were working that they had not been included. Due to changes in staff working hours there were several rotas being maintained. The inspector highlighted the need to maintain one rota, which should detail the actual hours worked including any changes. The home also provides an activities coordinator, the input of a psychologist and art therapy for 5 hours per week. Night time staffing consists of two waking staff. Staff have access to a training programme. The majority of the care staff have NVQ level 2 or 3 and there is always a Registered Mental Nurse (RMN) on duty. At the time of the inspection the home was in the process of recording the recruitment details for each staff member in order that personnel records can be held centrally. These showed that appropriate checks are carried out on Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 20 staff including obtaining written references and the completion of Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) applications. Staff were able to confirm that they underwent these checks. Staff confirmed that they received an induction, which involved the completion of a checklist. However, these checklists were not available. Records did not show that supervision had been taking for the year 2006 and this was confirmed by two staff. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. For the home to be effectively managed there is a need for a period of consistent management and the implementation of a quality assurance system. The home generally promotes the health and safety of residents, although this must be improved for fist aid training. EVIDENCE: Since the last inspection the home has had 3 different managers and a period of consistency is needed in order to address the matters raised in this report. This is being addressed by the appointment of an acting manager and plans for the recruitment of a permanent manager. Regular visits to the home are carried out by a representative of the owners, Truecare Holdings Ltd., in order to check the running of the service. A report is Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 22 completed following these visits. The home has other methods for assessing its 0001performance, including surveys of service users, their relatives and other involved professionals. There were no completed forms available at the time of the inspection. A ‘suggestions box’ is also situated near the entrance for residents and visitors to add their comments. The service needs to develop a quality assurance system based on an audit of the home and the views of service users. The home has neither a development plan nor a business plan. Records showed that the home’s equipment is serviced and maintained by suitably qualified persons. Staff are trained in first aid, although the home does not have a member of staff who has completed a four day qualified first aid course. Training is to be provided for staff in moving and handling and in infection control. Abbeyfield Lodge DS0000065818.V312312.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 3 27 3 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X X 2 Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 14 and 15 Requirement Each resident’s social, recreational, educational and occupational needs must be assessed and recorded. Care plans must be devised for these needs. Clear assessments and guidelines must be recorded to show that the home is taking action to minimise risks regarding behaviour and activities. This should be completed by liaison with local mental health services. Care plans must detail the indicators, signs and symptoms that medication ‘as required’ should be administered especially regarding agitation and distress. This is outstanding from the previous report. Timescale for action 12/01/07 2. YA9 15 12/11/07 3. YA20 13(4) 12/11/06 4. YA23 17 Schedule 4 (9) 17 Schedule 5. YA33 Records must be maintained to 12/12/06 show the amounts of monies being held on behalf of residents. This refers to the amounts held at the Truecare Holdings office. An accurate record must be 12/12/06 maintained of the staff duty DS0000065818.V312312.R01.S.doc Version 5.2 Page 25 Abbeyfield Lodge 4 (7) 6. 7. YA36 YA39 18 24 roster. Staff must have regular recorded supervision at least six times a year. The home must implement a quality assurance systems based on audit, obtaining the views of residents, including an annual development plan. Staff must be trained in first aid as follows: The home must have at least one staff member from the staff team who has completed a 4 day qualified first aid course. This is outstanding from the previous report. 12/12/06 12/01/07 8. YA42 13(4) 12/12/07 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 YA42 Good Practice Recommendations Temperature control devices should be installed on bath and shower hot water outlets. Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Abbeyfield Lodge DS0000065818.V312312.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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