Inspection on 01/08/07 for Abbeyfield St George`s House

This inspection was carried out on 1st August 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Abbeyfield St George`s House 31/07/08

Abbeyfield St George`s House 05/09/06

Abbeyfield St George`s House 23/02/06

Abbeyfield St George`s House 19/08/05

Abbeyfield St George`s House 25/03/05

Abbeyfield St George`s House 19/01/05

Abbeyfield St George`s House 28/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Abbeyfield St George`s House Park Terrace Westcliff On Sea Essex SS0 7PH Lead Inspector Pauline Marshall Unannounced Inspection 09:30 1 August 2007 st 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 St George`s House DS0000015412.V334860.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 St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield St George`s House Address Park Terrace Westcliff On Sea Essex SS0 7PH 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) 01702 331512 01702 342893 The Abbeyfield Southend Society Limited Post Vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: Abbeyfield St George’s care home provides care for twenty-five older people who do not fall within any other registration category. The home is decorated, furnished and maintained to a high standard. All personal accommodation is offered on a single occupancy basis. Twentyfour bedrooms have en-suite facilities. Each room has access to telephone and television points. The gardens are well maintained and attractive. There is parking available to the side of the building that can accommodate six cars. The home is situated in close proximity to Southend-on-Sea town centre, local community amenities and facilities. There is close access to local buses and the mainline train station to London. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. Fees range from £389.97 to £477.26 and there are additional charges for hairdressing, chiropodist, newspapers, telephone, toiletries and transport. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that lasted for five hours and thirty minutes. The process included a tour of the premises, a random selection of resident and staff files and discussions with residents, visitors, staff, a visiting professional, the manager and the homes service manager. As part of this inspection surveys were sent to six residents, six relatives’ six health and social care professionals and ten care workers to obtain their views on the service that the home provides. Two residents and two staff surveys were returned and were mainly positive about the home. The negative comments included that “sometimes the home is short of staff and that the meals are not as good as they used to be”. One of the staff surveys said “staff meetings and supervision do not take place regularly”. No other surveys were returned at the time of writing this report. Twenty-eight of the thirty-eight standards were inspected. What the service does well: The home provides good information for people wishing to live there. The home ensures that residents’ health care needs are met. Staff treats residents with respect and dignity. The home provides good activities for people to participate in and it helps residents to make decisions and choices in their daily lives. The home is well maintained; it is clean and tidy and has good quality furniture and fittings and residents have plenty of their own personal items around them. The home has well trained staff. The home ensures that all health and safety matters are dealt with. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Abbeyfield St Georges does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive up to date information to assist them in making an informed choice. A full needs assessment is carried out before admission and the home verbally confirms that it can meet the prospective residents needs. EVIDENCE: The Statement of Purpose and Service User Guide is in one document and contains details of the service that the home offers; it was last reviewed in June 2007. The document does not describe the range of activities offered and informs the reader that activities are displayed on the residents’ notice board in the main lounge. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 9 Each of the care files examined contained copies of individual residents contracts (terms and conditions) with the home. Each of the care files examined contained a pre-admission assessment, two of which were very thorough in detail; the other care file examined contained very scant information and many uncompleted areas on the assessment documentation. There was no evidence that the home had confirmed in writing that they could meet the needs of the resident; the manager said that this would be rectified on all new admissions and would be included in the Statement of Purpose. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans do not have clear instructions for staff on the level of intervention required for each resident. Residents’ health care appointments are not appropriately recorded to enable any follow up actions to be taken. Residents are responsible for their own medication where possible and the home has good medication policies and practice but does not have protocols in place for PRN (as and when) medication. Residents are treated with respect and their privacy is upheld. However, there is no information available on residents’ wishes at the end of their lives. EVIDENCE: Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 11 Three care files were examined and did not contain clear instructions to staff on the level of intervention required. The manager said that these are in the process of being reviewed and she has obtained care-planning documentation that will replace the current format. The daily notes were clear and informative and included details of any health appointments and their outcomes. It was difficult to track any necessary actions that were required from residents’ health care appointments as the details of these were within the daily notes and not recorded elsewhere to highlight where any instructions could be located. A discussion took place around how any follow up actions could be missed due to this method of recording and the manager said that the new care plan documentation included a tracking sheet, that would ensure follow up actions are carried out. Medication is stored in the homes treatment room together with any district nurses notes; the treatment room is kept locked at all times when not in use. Senior staff order and administer medication and have all received medication training. The MARS (medication administration record) showed that PRN (as and when medication) is prescribed for several of the homes residents and there are no protocols in place describing why, how, when, what dose and how often it should be administered. Residents spoken with said that they felt well treated by staff and visitors spoken with confirmed that staff are pleasant and helpful. Staff were observed treating residents respectfully throughout the inspection. The three residents files examined did not contain any information on the residents’ end of life wishes. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers its residents a range of activities and the opportunity for community contact when possible. Residents are helped to exercise choice and control over their lives. A good range of home cooked food is offered but residents would benefit from having other alternatives to chicken. EVIDENCE: Abbeyfield St Georges offers its residents a range of activities daily that includes videos; nail care, visits from local school children and religious services. The manager said that bingo and quizzes have been offered but were only taken up by one resident; there are plans to introduce more live entertainment to encourage residents’ participation. A relatives survey stated “there is a marked absence of any sort of activity recently”. The manager said Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 13 that she plans to delegate to one of the care workers the activity co-ordinator role on a daily basis between the hours of 2pm until 5pm Residents spoken with said that they occasionally go out to the local shops and the manager said that residents have requested through their last residents meeting to go out to local cafes and pubs. Residents have aperitifs each day at 11.30am and are offered a choice of sherry or any other drink of their choosing. Residents spoken with confirmed that residents meetings take place but the notes were not located at the inspection; the manager said that the most recent meeting notes had not yet been typed. The dining area is spacious and nicely laid out; tables are set and vegetables are served in terrines and gravy in gravy boats to enable residents to serve themselves where possible. The lunchtime meal was liver and bacon, mashed potato, mixed vegetables and brussel sprouts and there was an alternative of cold sliced chicken. The dessert was a choice of pavlova, trifle, rice pudding or gateau and was offered to residents off of the dessert trolley. The Cook said that the four-week rolling menu has been designed at the residents’ wishes and that the daily alternative of chicken was at residents’ requests. Residents spoken with varied in this view and some said they liked chicken as the only alternative and others said they would like more variety and that the cook would do an alternative if required. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Issues are taken seriously by the home and residents can be confident of swift action if they have cause for complaint. To ensure appropriate action is taken the home needs to acquire the appropriate Local Authorities Adult Safeguarding procedures. EVIDENCE: The home has a written complaints procedure that is issued to all residents prior to admission and is displayed on the homes notice board. The complaints book could not be located so the manager recorded three minor complaints in her diary but these did not contain details of the actions taken to rectify them. The manager has now set up a complaints folder and details of the three complaints received this year will be transferred in to the folder and have a full account of the homes response. The home has its own policy and procedure for dealing with Adult Safeguarding issues and this works within the Southend on Sea Borough Councils procedure. Staff has received Adult Safeguarding (protection of vulnerable adults) training Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 15 but the manager intends to provide an update to ensure that all staff understands their roles and responsibilities within the procedures. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 16 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): 19, 24 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe well-maintained environment and bedrooms meet their individual needs. The home is clean, pleasant and hygienic. EVIDENCE: The home shares a maintenance man with other Abbeyfield Society properties and repairs are carried out swiftly. The manager works closely with the property manager and together they plan any repairs and replacements. The home has recently replaced their tumble dryers, their washing machines and has had new improved lighting and security installed. All rooms are single en-suite and are spacious and comfortably furnished with many residents’ personal items including some larger pieces of furniture. All of the bedrooms are carpeted; the manager and property manager said that Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 17 when a room is vacated it is redecorated and the carpet is replaced if necessary. Two domestic staff work each day throughout the week and the home was clean, pleasant and hygienic. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are well trained, competent and supplied in sufficient quantities to meet residents needs. The current recruitment practice is unsafe and does not protect the residents. EVIDENCE: The home has a care staff rota, a kitchen rota and a domestic rota and the entries reflected the staff on duty at the time of the inspection. The rota did not identify the staff designation and who was in charge of the home. The rota did not contain full staff names and not all of the abbreviations were explained. Seven care staff have completed NVQ training and a further six staff are undertaking the award. Three staff files were chosen at random for examination and two of these could not be located. The third staff file did not contain any evidence of fitness and had a copy of a CRB (Criminal Records Bureau Check) from another employer. Two further staff files were examined; one for an individual that commenced Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 19 work at Abbeyfield on 16/5/07 that contained induction and supervision documents only. The other staff file examined did not contain a CRB. A further staff file examined contained a negative CRB check and there was no evidence on the file to say that a risk assessment had been completed. The manager said that a risk assessment had been carried out on this issue recently and was in the process of being typed. The manager has prepared a training matrix and this identifies any training already undertaken and the date that further training is required. The training matrix evidenced that staff had undertaken first aid, food hygiene, health and safety, moving and handling, fire safety, medication, COSHH (Control of Substances Hazardous to Health) and POVA (The Protection of Vulnerable Adults) within the last year. Copies of training certificates for the three staff files examined could not be located. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the residents and their financial interests are safeguarded. The health, safety and welfare of the residents is promoted and protected. Staff receives regular supervision. EVIDENCE: The manager has been in post since 28/5/07 and is a Registered General Nurse and begun her Registered Managers Award with her last employer, which she is about half way through completing and hopes to register with the local college to commence again in September 2007. The manager has Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 21 experience of managing older peoples services and was previously a deputy manager, then she was the manager in a care home. The home returned its completed Annual Quality Assurance Assessment (AQAA) by the due date. The home has one resident that deals with their own finances and holds small amounts of cash for sixteen residents whose families deal with the finances and provides the home with “pocket money”. Two residents finances were reconciled and were correct. All residents’ cash is kept in the homes safe. There was evidence of supervision in the staff file examined and the manager has set up a supervision schedule. All safety certificates were in place and up to date. The home has not carried out any fire drills although reminds residents of the procedure at every residents meeting. The manager said that she would be implementing fire drills at least twice a year, as the practice would benefit staff and residents in the event of a real fire situation. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 22 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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 3 X 3 Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14 (1) (d) Requirement Accommodation must not be provided to a resident unless it has confirmed in writing to the resident that the home can meet their needs. A written care plan must be in place that identifies how the residents’ needs in respect of his/her health and welfare are to be met. The care plan must identify the level of staff intervention required. This is a repeat requirement. 3. OP9 13 (2) The arrangements for the administration of medicines in the care home must be safe. Protocols for PRN (as and when) medication must be in place. This is a repeat requirement. 4. OP29 19 (1) (i) Staff cannot be employed to work at the care home unless all the information as required in DS0000015412.V334860.R01.S.doc Timescale for action 30/11/07 2. OP7 15 (1) 30/11/07 30/11/07 30/11/07 Abbeyfield St George`s House Version 5.2 Page 24 schedule 2 has been obtained. This refers to the absence of staff files and the need to obtain own CRB checks and evidence of fitness. This is a repeat requirement. 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. 4. Refer to Standard OP11 OP16 OP27 OP15 Good Practice Recommendations The home should obtain residents end of life wishes and record them in the care plan. All complaints and any required actions should be fully recorded in the homes complaints record book. The staff duty rota should show staffs full name and designation and it should identify who is in charge of the home and any abbreviations should be explained. The residents should be offered an alternative choice of meal instead of chicken that is the alternative offered on the menu every day. Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Abbeyfield St George`s House DS0000015412.V334860.R01.S.doc Version 5.2 Page 26 - 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!