CARE HOMES FOR OLDER PEOPLE
Abbeyfield Residential Care Home 40 The Grove Gosforth Newcastle Upon Tyne Tyne & Wear NE3 1NH Lead Inspector
Janine Smith Unannounced Inspection 22nd November 2005 10.50 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 DS0000000429.V257573.R01.S.doc Version 5.0 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. DS0000000429.V257573.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Abbeyfield Residential Care Home Address 40 The Grove Gosforth Newcastle Upon Tyne Tyne & Wear NE3 1NH 0191 285 2211 0191 285 2211 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) Abbeyfield Newcastle upon Tyne Society Mrs Kath Brown Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places DS0000000429.V257573.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th June 2005 Brief Description of the Service: The Abbeyfield residential care home at 40 The Grove, Gosforth, provides care for up to thirty-two frail elderly people. Nursing care is not provided. The building is of an older style but has been adapted well. There are a variety of aids and adaptations around the building to help residents to move about more independently. Single bedrooms are provided throughout and each has an ensuite toilet. The bedrooms are located on the ground and first floor of the building, which has a passenger lift. The home has several lounges and dining areas. Two assisted baths and one shower are provided, along with four separate toilets. The home is set within large grounds filled with mature plants, which are well maintained. The Abbeyfield Society runs this home. DS0000000429.V257573.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took 6 ¾ hours and the home had not been given advance notice. An inspection was made of part of the premises and a sample of records. The system for the storage, handling and administration of medication was looked at, as well as the systems for handling residents’ financial affairs. Six of the residents and three staff were spoken to. What the service does well: What has improved since the last inspection?
Three care records were inspected. These showed that re-assessments were being carried out at regular intervals. The care staff had made regular notes in the care records as to each resident’s wellbeing, which helps ensure good communication between each shift. There was evidence that residents were being weighed at least monthly and appropriate action had been taken where a resident was unintentionally losing weight. Checks of the Protection of Vulnerable Adults (POVA) List are being made before new staff are employed, which helps safeguard residents living in the home. Two carers are being trained about the needs of people with dementia type conditions. Fire drills are being carried out regularly. DS0000000429.V257573.R01.S.doc Version 5.0 Page 6 What they could do better:
In order to meet regulatory requirements, some things must be done better. The records were found to contain relevant individual plans of care but not all needs were covered. For example, the care plans did not include details of specific health problems or sensory impairments. The inspector spoke with a carer who was well informed about the needs of these residents, although the information was not specifically included in a plan of care. However, in order to avoid reliance on verbal communication, it remains important for the written care plans to contain full information to ensure that it is readily available to all staff, including temporary agency staff. The care plan must, therefore, detail all care needs identified through the assessment process. The previous timescale for achieving this has been extended. New documents have been put into use for recording the outcome of consultations with dentists, opticians and chiropodists. However, this is not yet in place for all of the residents and there were still gaps in recording. Residents’ wishes and needs concerning regular health care check ups on eyes, mouth care, hearing, etc., must be recorded in their care plan. Residents must be offered assistance to obtain routine health care check ups at appropriate intervals. The outcome of such check ups must be clearly recorded in their plan of care. An assessment process has begun to identify residents’ risk of having falls but this has not been carried out for all residents. Also, all residents have not yet been assessed to identify those at risk of developing pressure sores. This work needs to be carried out to help reduce the risk of residents having falls or developing pressure sores by taking preventative action. The dosage instructions for some medications were not written out fully which could lead to mistakes being made. Sometimes the carers had not written down whether a medication had been given or not, which could also lead to mistakes being made. The numbers of staff on duty are satisfactory, providing that there is full time management support. However, the Manager is preparing meals on some days of the week, as the Society has been unable to recruit a suitable cook/chef and the other chef was on holiday. This means the Deputy Manager must take over some managerial tasks, which reduces the amount of time available for direct care of residents. Where the Manager is required to take over catering duties, sufficient management cover must be provided to ensure that the staffing requirements applicable to the home are met. Recruitment checks still need to be improved so that appropriate references are obtained. DS0000000429.V257573.R01.S.doc Version 5.0 Page 7 There were some minor inaccuracies in two of the three records showing the money held on behalf of residents. Greater care needs to be taken with this. No records are being kept to show when personal allowances, received on a resident’s behalf, are given to the resident. This must be done. The inspector saw two staff use a wheelchair to move a resident without using the footrests. This practice puts residents at risk of injury to their feet or legs. The Manager must ensure that the staff are trained and use safe techniques when assisting residents. The temperature of hot water supplied to a bath was again higher than that advised for safety. This needs to be attended to. The home were advised at the last inspection that linen cupboards should be kept locked as the Fire Brigade have advised. However, this is not being done. 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. DS0000000429.V257573.R01.S.doc Version 5.0 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 DS0000000429.V257573.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 5 were assessed at the last inspection. Intermediate care (Standard 6) is not provided. EVIDENCE: DS0000000429.V257573.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7, 8 and 9. There are generally good arrangements in place to ensure that residents’ health care needs are met, but care planning and risk assessment need to be improved. This will help to ensure that the staff team are fully informed and aware of the support they need to provide to each resident. The home must make sure every resident is offered support to obtain routine health check ups, as it seems there are some being missed. The systems for the administration of medication need some improvement for the safety and wellbeing of residents. EVIDENCE: A requirement was made to make improvements in the assessment and care planning processes following the last inspection and a complaint. The deputy manager confirmed that the care plans are being re-organised and developed. Three care records were inspected. These showed that re-assessments were being carried out at regular intervals. The care staff had made regular notes in the care records as to each resident’s wellbeing, which helps ensure good communication between each shift.
DS0000000429.V257573.R01.S.doc Version 5.0 Page 11 The records were found to contain relevant individual plans of care but not all needs were covered. For example, the care plans did not include details of specific health problems or sensory impairments. The inspector spoke with a carer who was well informed about the needs of these residents, although the information was not specifically included in a plan of care. However, in order to avoid reliance on verbal communication, it remains important for the written care plans to contain full information to ensure that it is readily available to all staff, including temporary agency staff. The care plans were being reviewed monthly but were slightly overdue for review at the time of inspection. A new document has been started for recording the outcome of consultations with dentists, opticians and chiropodists, however, this is not yet in place for all of the records and there were still gaps in recording. The record for one resident, who is partially sighted and wears glasses, indicated that she had not seen an optician for over five years. The Deputy Manager was not aware of the reasons for this. An assessment has been introduced to identify residents’ risk of having falls but this has not been carried out for all residents. However, there was evidence that advice had been sought from the GP and a physiotherapist for a resident who had experienced several falls. As a result, some equipment had been obtained to help keep her safe. All residents have not yet been assessed to identify those at risk of developing pressure sores. There was evidence that residents’ physical and psychological wellbeing was monitored and doctors contacted when necessary. There was also evidence that residents were being weighed at least monthly and appropriate action had been taken where a resident was unintentionally losing weight. Six residents were spoken to and all said that they were well cared for and treated well by the staff, although one said newer staff could be abrupt. One resident said, “Its jolly nice here, I like it”. One resident said that they did not like the food and said that they wanted more white bread to be offered. Another said the food was good, but due to problems with her teeth, she found the evening meals boring but enjoyed others. Another resident said the food was very good and varied. Another resident said that they were treated very well and were able to live their life as they wanted and be independent as far as possible. He had also enjoyed the social activities provided in the home. A random sample of medication records and the system for storage and handling medication was looked at and found to be appropriate, other than:
DS0000000429.V257573.R01.S.doc Version 5.0 Page 12 - The dosage instructions for one medication were not recorded on the medication administration record; - The dosage instructions written on the medication administration record for one medication conflicted with the instructions given by the pharmacist; - The additional administration instructions for two medications were not recorded on the medication administration record; - There were unexplained gaps in the medication administration records. The Deputy Manager was also advised that any handwritten changes to the dosage instructions should be signed and dated. Senior carers have been trained by the responsible community nurse to carry out blood glucose monitoring for residents with diabetes. However, there is no written evidence that each carer has been assessed as competent to carry out these tasks. It was recommended that the responsible community nurse document the training given and confirm in writing that each individual carer is competent to carry out this task. The individual care plans must also specify the checks, treatment and responsibility of all staff. It was recommended a thermometer be placed in the medication storage area to enable the room temperature to be checked. DS0000000429.V257573.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Standards 12, 13 and 15 were assessed at the last inspection. Residents are helped to exercise choice and control over their lives, which means their wishes and rights are respected. EVIDENCE: Residents are encouraged to handle their own financial affairs for as long as they wish or are able to. Some residents also prefer to look after their own medication and the Deputy Manager described how this is monitored to ensure that residents’ remain safe. A resident confirmed that they had been able to bring their own furniture for their bedroom. Another resident said he was sure the home would allow him to read the records written about him, if he wanted to do this. Information about a local Advocacy Scheme is displayed on the notice board. DS0000000429.V257573.R01.S.doc Version 5.0 Page 14 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 the following standard(s): Standards 16 and 18 were assessed at the last inspection. EVIDENCE: The Deputy Manager stated that one complaint had been made direct to the home since the last inspection. The Commission also received and investigated a complaint about the quality of care provided to a former resident. Some parts of the complaint were upheld and requirements were placed on the home to improve assessment and care planning processes and the handling of medication. Some further work is still required to improve care planning and medication handling and timescales for achieving this are stated at the end of this report. DS0000000429.V257573.R01.S.doc Version 5.0 Page 15 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 the following standard(s): Standards 19-26 were assessed in full at the last inspection. The building provides a suitable homely environment for older people who require care. EVIDENCE: A brief tour was made of the premises and four residents’ bedrooms were seen. DS0000000429.V257573.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29. Usually, there are enough staff on duty to meet the needs of residents. However, more pressure is placed on care staff, when the Manager is carrying out catering duties. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. Standards 28 and 30 were assessed at the last inspection. EVIDENCE: Examination of staff rotas and discussion with the Deputy Manager and members of the staff team provided evidence that the numbers of staff are as follows:8 a.m. to 10 p.m. 5 10 p.m. to 8 a.m. 3 (sometimes 4) waking This is enough to meet the needs of residents, providing that there is full time management support. However, currently the Manager is preparing meals on some days of the week, as the Society has been unable to recruit a suitable cook/chef and another chef was on holiday. This means the Deputy Manager must take over some managerial tasks, which reduces the amount of time available for direct care of residents. Where the Manager is required to take
DS0000000429.V257573.R01.S.doc Version 5.0 Page 17 over catering duties, sufficient management cover must be provided to ensure that the staffing requirements applicable to the home are met. The records of two recently employed staff were examined. Satisfactory checks of the Protection of Vulnerable Adults List (POVA List) had been obtained before they were employed. However, recruitment checks still need to be improved. The records of one person showed that two separate written references had been obtained but both were from the same person. A written reference had not been obtained from the last employer. In the other case, satisfactory references had been obtained. DS0000000429.V257573.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38. Record keeping in respect of residents’ financial affairs is not as thorough as it needs to be for the protection of residents and staff. Some health and safety issues need to be dealt with to ensure that the home provides a safe environment for residents. Standards 31 and 33 were assessed at the last inspection. EVIDENCE: The system for handling and storing money held on behalf of residents was looked at. This was found to be appropriate, however, an audit check of three residents’ records showed that the balances held did not match that recorded in the records in two cases, one being 14p less, and the other 1p over. DS0000000429.V257573.R01.S.doc Version 5.0 Page 19 Clear records are held showing the amount of charges due and fees paid. No record is being kept where personal allowances are actually handed over to the resident to whom it belongs. This must be done. The following health and safety concerns were raised with the Deputy Manager during the inspection. The inspector saw two staff move a resident by wheelchair without using the footrests provided. This practice could place the resident at risk of injury and should cease. The temperature of water supplied to one bath was too hot, at 48° centigrade. It was recommended at the last inspection that linen cupboards be kept locked as advised by the Fire Brigade on the warning signs on the cupboard doors. However, this is not being done. The Fire Log Book indicated that fire safety checks and fire drills are carried out at the frequency recommended by the Fire Brigade. DS0000000429.V257573.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 2 DS0000000429.V257573.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15 Requirement The care plan must reflect all care needs identified through the assessment process, as set out in Standard 3.3. and 7.2. The previous timescale of 31/8/05 has not been met. Residents’ wishes and needs concerning regular health care check ups on eyes, mouth care, hearing, etc., must be recorded in their care plan. Residents must be offered assistance to obtain routine health care check ups at appropropiate intervals. The outcome of such check ups must be clearly recorded in their plan of care. All service users must be assessed, by a person trained to do so, to identify those who are at risk of developing pressure sores. Appropriate interventions must be put in place and recorded in their plan of care where necessary. The dosage instructions for each medication must be recorded accurately and in full on the medication administration
DS0000000429.V257573.R01.S.doc Timescale for action 31/03/06 2 OP8 12 31/12/05 3 OP8 12 31/03/06 4 OP9 13 31/12/05 Version 5.0 Page 22 record. Any handwritten changes to the prescribed medications should be signed and dated on the medication administration record. The medication administration record must be signed when a medication is given. Or the appropriate code must be used if the medication has not been given. 5 OP27 18(1) Sufficient management or care 31/12/05 staffing cover must be provided when the Manager is required to carry out catering duties to ensure that the Home complies with the ‘Staffing Requirements and Good Practice Guidelines’ issued by Newcastle City Council. Two satisfactory written 31/12/05 references must be obtained employment to the employment of staff, including, where applicable, a reference relating to the person’s last period of employment which involved work with children or vulnerable adults. Accurate records must be kept of 31/12/05 money held on behalf of residents. A record must be kept to show when personal allowances, received on a resident’s behalf, are given to the resident. Both the resident and responsible member of staff should sign the record. Safe practice must be observed when transporting residents by wheelchair. Footrests must be used at all times. 6 OP29 19(1)(b) 7 OP35 17(2) 7 OP38 13(5) 31/12/05 DS0000000429.V257573.R01.S.doc Version 5.0 Page 23 8 OP38 13(4) Ensure that the thermostatic control device on the bath is functioning correctly to deliver hot water at no more than 43o centigrade. Monitor the temperature of hot water at regular intervals and always before bathing residents. 30/11/05 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 OP9 Good Practice Recommendations The responsible community nurse should document the training given in respect of blood glucose monitoring and confirm in writing that each individual carer is competent to carry out this task. The individual care plans must also specify the checks, treatment and responsibility of all staff where such tasks are carried out. A thermometer should be placed in the medication storage area so that the room temperature can be monitored. 2 OP38 Keep linen cupboard doors locked for fire safety reasons. DS0000000429.V257573.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 DS0000000429.V257573.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
