Inspection on 09/09/08 for Abbeyfield Stangrove Lodge

This inspection was carried out on 9th September 2008.

CSCI found this care home to be providing an Adequate service.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeyfield Stangrove Lodge 10/09/07

Abbeyfield Stangrove Lodge 04/10/06

Abbeyfield Stangrove Lodge 10/10/05

Abbeyfield Stangrove Lodge 22/06/05

Abbeyfield Stangrove Lodge 05/10/04

Abbeyfield Stangrove Lodge 13/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbeyfield Stangrove Lodge Manor House Gardens Edenbridge Kent TN8 5EG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jenny McGookin     Date: 1 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Abbeyfield Stangrove Lodge Manor House Gardens Edenbridge Kent TN8 5EG 01732864975 01732866435 ruth.mills@abbeyfieldkent.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Kent Society Name of registered manager (if applicable) Ruth Mills Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 49. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Stangrove Lodge is located in a quiet residential area within easy walking distance of local shops. All accommodation is on the ground floor. The home is divided into 4 separate residential Units. There are plenty of communal areas for residents to access and the majority of bedrooms are single. The gardens include an enclosed sensory garden, which is attractively laid out and well maintained with a paved area and seating, the garden is easily accessible from the home. 24 hour care and support is Care Homes for Older People Page 4 of 36 care home 49 Over 65 0 49 49 0 Brief description of the care home provided to older people, some of whom have Dementia. The current fees range from 485-665 pounds per week. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This report is based on two site visits, the first of which was unannounced and the second (the following day) was by prior arrangement. These site visits were used to inform this years key inspection process; to check progress with matters raised from the last key inspection (September 2007); and to review findings on the day-to-day running of the home. The inspection process took fifteen and a quarter hours, spread over the two days. It involved meetings with one group of three residents over lunch, a visiting friend, and Care Homes for Older People Page 6 of 36 three visiting relatives. It also involved meetings with a number of individuals representing a range of functions of the home - the manager; two senior carers; four carers; one of the homes two cooks and two volunteers. We also observed interactions between service users and staff at various stages throughout our visits. We took a selection of feedback questionnaires with us for distribution to residents, relatives and visiting professionals. Feedback was obtained from four residents, two staff, three relatives, a healthcare professional and a care manager, in time for the issue of this report. Any others will be used to inform the Commissions intelligence in due course. Consideration was given to the Annual Quality Assurance Assessment submitted by the manager in June 2008, ahead of its due date. The AQAA is a self-assessment that focuses on how well outcomes are being mate for people using the service. It also gives some numerical information about the service. The inspection also involved an examination of records, including three residents case files, to track their care and a selection of personnel files. Four bedrooms, selected at random, were checked for compliance with the National Minimum Standards on this occasion, along with some communal areas. What the care home does well: What has improved since the last inspection? The homes AQAA told us about a number of improvements since the last key inspection, as a result of listening to people who use the service. - Prospective residents are being offered longer periods for assessments, to help ensure the home can meet their needs. - Care planning practice is reported to have been improved, and staff have been given training in the principles of person-centred care planning, updated by Care Practice Awareness sessions. Care reviews and residents meetings are also reported to include equality issues to ensure the home is inclusive. - The quality of care files has been improved and these are being reviewed monthly by senior staff to ensure practice standards are being maintained. - Residents should be able to see that the homes menus include dishes they have chosen, and the cook is producing more home-baked food and a wider range of dishes. - The residents are being offered more outings and a wider range of activities. Those who cannot travel far are taken to the local town. - The residents now have a wider range of sensory equipment and carers are reported to have been trained to use the sensory room as part of residents therapy. - The home actively liaises with Abbeyfields Head of Quality and families to ensure complaints are addressed. There have been improvements to the staffing arrangements, which were judged poor at the last inspection: - The manager tells us she is close to completing her Registered Managers Award training. - We were told that staffing numbers and deployment had been improved around the units to meet residents needs. - All staff are offered training to raise their awareness of equality and diversity issues. An Equal Opportunities monitoring form and disability statement accompanies each application form. And this is reported to be followed through with induction, training and appraisals. - Staff have regular dementia training - at a basic awareness level, though more are doing a more advanced level of training. - Care staff have also had training in infection control, catheter care, food, fluid and nutrition awareness, and the prevention of pressure sores and falls. - The current laundry lady has been commended for the way laundry is being kept in good order. - We were told that regular group supervision sessions were being undertaken to promote team working. There have been improvements to the building, which was judged adequate at the last key inspection: Care Homes for Older People Page 8 of 36 - Odours and cleanliness are reported to be better managed. Having new carpet shampooers at each end of the home has helped ensure they are readily accessible to rooms and corridors. - The decor in each unit has been improved. Corridor ceilings have been replaced and lighting in each corridor has been updated. - A new large conservatory has been installed on the Tudor unit and the Tudor lounge has been refurbished. - New lounge chairs have been introduced into all units and some curtains and carpets have been replaced. We`were told that the colours were chosen by the residents. - There have been improvements to the toilet facilities - old WCs have been replaced and surfaces have been re-tiled, flooring renewed. - More effort is being made to keep fire exits clear and rubbish is being disposed of properly now that another bin is in place. - Some exits and pathways have been pressure washed, repaired and re-pointed. - The site has also benefited from tree work. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Care Homes for Older People Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives benefit by having access to most of the information needed to decide whether this home would meet their needs. Prospective residents can feel confidant that their needs will be properly assessed and that they will be supplied with a contract, which clearly tells residents about the service they will receive. This home does not provide intermediate care. Evidence: This home has a combined Statement of Purpose and Service User Guide, which is intended to be read in conjunction with other separate documents (obtainable on request from the office), to describe the homes range of facilities, services and service Care Homes for Older People Page 12 of 36 Evidence: principles. Two people who had submitted feedback questionnaires said they did not have enough information at the start. And we have raised a number of matters to obtain further compliance with the provisions of this standard - these were reported back to the manager separately, to ensure that prospective residents or their representatives could be confident that they have all the information they need to reflect on, in order to make an informed decision. The home was not able to evidence whether other languages or formats were warranted. A checklist would compensate for residents not being able to recall having received this information with any accuracy when we asked them. Relatives and residents told us that the decision to apply to this home was in practice influenced more by its locality (i.e. closer to where they lived), or prior knowledge of the home than by any public information produced by the home itself. One resident told us I had no choice. My son moved me here straight from hospital, but I am happy here. We found good evidence of pre-admission assessments, which routinely took into account any assessments carried out by funding authorities. And feedback confirmed that prospective residents (where able) or their representatives could visit the home before the admission, to meet the staff and other residents. A trial stay of one month is available and we were told this could be extended for further assessment. All residents spoken to said they were happy with the choice of home. On their admission the home carries out further assessments, including risk assessments. Funding authorities have their own contract terms and conditions, which are outside the scope of this inspection. But each self-funded placement is subject to Abbeyfields own licence agreement. We judged the format of this document comprehensive, but felt it could make more pointed reference to care plans (as with other key documents) as these effectively extend the provisions of the licence agreement. And we judged our recommendation about a checklist to evidence whether other languages or formats are warranted (see above), applied here. The home can generally demonstrate its capacity to meet the needs of residents - see the section on Health and Personal Care for a description of service provision., But see also the section on Staffing for our findings in respect of deployment and training. This home does not provide intermediate care. Should the home provide rehabilitation of convalescence, all the elements of National Minimum Standard 6 will apply. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the health and personal care they receive, is based on their individual assessed needs. Residents can be confident that the principles of respect, dignity and privacy are generally put into practice, though one or two staff will require further investments to ensure this. Evidence: Three residents files were selected for case tracking on this occasion, to represent admissions over the past 12-18 months. The format of the care plans used by this home properly identify a range of health and personal care needs in the first instance, and these are supplemented by daily reports, assessments (including risks) and records of contact with healthcare professionals. Training in person-centred care has been given to staff, to try to ensure a rounded approach, and there are regular Care Practice Awareness training sessions to Care Homes for Older People Page 14 of 36 Evidence: maintain their awareness of key principles of person-centred care and dementia. This home has a key-worker system to help ensure a meaningful rapport can be built up between staff and residents. And we were told that since the last inspection senior staff have been tasked with reviewing care plans every month, to ensure practice standards are being maintained. Feedback from residents and relatives indicates that many staff have impressed them with their level of care, and that the daily routines are generally as flexible as healthcare needs and staffing levels will allow. One resident told us, all the carers are very hard working, and are always really nice. Another said s/he was very happy with the care I receive. One relative told us, I feel Stangrove have welcomed my mother and made her and me feel very happy. They have more than helped with her individual needs, and understood her situation and dealt with them. I cant thank them enough for understanding and dealing with the situations as they arise. They are always all very busy - but never hesitate to stop and take the necessary time to comfort and care. We are more than happy with the level of care at the present time. Thank you. But feedback also included some mixed comments. One healthcare professional told us, there are some exceptional staff with experience, understanding, skills and attitude who appear to be very motivated to provide best for their residents (and frustrated when not able to do so due to resources). In contrast, one or two members of staff appear to view residents as potential problems (behavioural) rather than individuals with their specific needs. This is probably rather universal in care homes. And we were also told, in terms of seeking advice on mental health issues staff have been (and are) active. These have usually been adhered to, although there have been occasions when this has not been the case (mostly related to resources, or lack of). Another source told us that while they couldnt praise cleaning staff highly enough they are brilliant, they had noted little things like individuals hairbrushes in need of better upkeep. In common with other homes in the Abbeyfield group, this home relies heavily on its day-to-day rapport with service users and their relatives to review care plans - there are no formal multi-disciplinary reviews except those led by funding authorities. Only one or two residents showed any recognition of the process, though their representatives / relatives were better able to. They did confirm being asked questions about their care on a day-to-day basis. Records confirm that residents have access to a range of medical services, according to need. Unless subject to a GP referral, residents would need to pay for additional medical treatment of medication themselves. Two bedrooms are designed to be double rooms but in practice all are used for single occupancy, which means health and personal care can always be given in privacy. We were told that staff have been given a range of relevant training - see section on Staffing for more details. The home uses the Monitored Dosage system for medication administration, which is Care Homes for Older People Page 15 of 36 Evidence: dispensed over a 4-week cycle. There were no gaps or anomalies in the records we spot checked on this occasion. Records confirmed that staff are trained to administer medication, but they have raised concerns with us over the length of time medication rounds can take, if there arent two staff to dispense them. Our own records confirm that no errors have been reported to the Commission since the last inspection visit. The homes medication is kept properly secured when not in use. Some matters were raised for attention, however, in respect of the homes medication room, which is also used by visiting district nurses, to improve its capacity to withstand contamination. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise some choices over their daily life style, subject always to their assessed needs and the availability of friends, relatives or staff. The social, cultural and recreational activities offered by the home will meet some expectations, but this area requires further investment. Residents can be confident that they will be supported to keep in contact with family and friends. Residents can be confident that they will receive a healthy, varied diet according to their assessed requirements and choice. Evidence: We were given mixed messages about this aspect of our inspection. We were told, I just havent got the energy to join in I enjoy board games and outings. These are available. (There should be) more activities and stimulation for residents. I realise in a dementia unit it is more difficult to keep concentration but a little more effort in this area would be helpful, as all levels have to be catered for, and can be a bit spasmodic Care Homes for Older People Page 17 of 36 Evidence: at times. Hes a bit of a lad for sleeping. Residents were not not individually able to give many examples of any particular hobbies or activities promoted by this home, and the home does not currently have assured input from a dedicated activities co-ordinator - particularly where staffing shortfalls require cover. Activities are, therefore, always subject to personal choice and the availability of friends, relatives or staff (see also section on Staffing). Records did show a modest range of activities, including: music (e.g. piano and sing songs), gentle exercises, reminiscence, reading or looking through papers or magazines, Scrabble, jig saws and card games, Bingo, PAT dog visits and outings. During our visit we met with one volunteer who visits regularly with a trolley shop. Residents have hairdressing and nail care sessions as well as hand massages, and aromatherapy. And they can also have access to the homes sensory room and equipment (though the frequency of this appears to be variable and the member of staff who showed us this was not conversant with the way things worked). The home has a communal TV in each unit, and the use of a Digi-box, so there would be some scope for choice if they could move from unit to unit or did not already have a TV in their bedrooms. We were told that the home would be buying two portable TVs, Sky TV connection and a portable loop system (for use with hearing aids) but there was no time frame for any of this. Like other homes in the Abbeyfield group, this home has detailed templates for carrying out assessments of residents spiritual needs, which is judged exemplary in its scope, though one was left blank in the files we looked at. Records confirm there are Church services on site, and that televised services are viewed. During our visits we met with one volunteer, who use to provide chaplaincy services, who now organises services on site. But she told us the home had not been able to secure representation from all denominations. The Baptist church represents one unmet need for example. Residents can choose when to go to bed or get up, as far as they are able (though one source suggested otherwise), and they were observed being supported to make some choices and decisions during our site visits. Residents are also able to have visitors at any reasonable time and can stay for meals (a small donation is requested). And the home is reasonably well placed for links with the local community. There is a pay phone in a kiosk and residents have the use of a cordless handset, to ensure conversations can be held in privacy. Unless other arrangements have been made, residents receive their mail unopened. Care Homes for Older People Page 18 of 36 Evidence: Catering needs are properly identified as part of the pre-admission process and updated or amended thereon. There is a four-week cycle of menus drawn up by head office, which the cook told us she goes round to residents individually to check. And the home gets its supplies (including regular fresh fruit and vegetables) from a range of sources. Some special diets can be catered for - we were told about diabetic diets and diets for people with allergies. And there is some equipment available such as large handled cutlery and beakers. We were assured that where liquidised meals were called for, each component was being liquidised and presented separately on the plate, so that people could enjoy their individual tastes, textures and aromas. We were, however, surprised to learn that the cooks have not had any specialist training in catering for people with dementia, given the special challenges this can present. This is strongly recommended. We joined the residents for lunch on both days and judged the meals tasty and well presented. The home uses feedback questionnaires to evaluate responses to selected meals, and our own questionnaires indicated the meals were usually enjoyed We observed how one or two hostile interactions between residents were managed at one sitting. This required careful interventions and the reconfiguration of seating arrangements. We also observed two residents being fed, and this was done with quiet coaxing and prompting. Occasional smiles from the residents indicated some recognition and readiness to co-operate. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their complaints will be addressed properly through the homes complaints procedure. Residents can feel confident that they are protected from abuse. Evidence: Relatives told us, I cannot remember having any concerns. I havent had a need to raise any care concerns. Abbeyfield has a clear complaints procedure, which is detailed in the homes combined Statement of Purpose and Service User Guide, and is also available as a separate document on request. The home keeps a loose-leaf ring binder of complaints. We did not judge this sufficiently confidential, though we understood access to its detailed contents is restricted to only those properly authorised. We also judged the contents should be indexed and better secured against loss or disarray. Like other homes in the Abbeyfield group, this arrangement is subject to quarterly audits and findings are included in Abbeyfields own unannounced monthly inspections, so the company is always aware of emerging issues. Care Homes for Older People Page 20 of 36 Evidence: The range of complaints was judged a realistic reflection of communal living (e.g. building and property matters, occasional staffing arrangements, the impact of a mix of residents on each other, activities, catering and laundry) and there was good evidence of the homes response in each case. Residents and their representatives can have confidence that the homes culture is to take concerns and complaints seriously. The home has information on independent advocacy services on display, but families and friends tend in practice to be relied on to provide this. We were told that since the last inspection staff have all had training in dementia awareness, to ensure residents scope for making decisions for themselves is properly promoted. Like other homes in the Abbeyfield group, Stangrove Lodge has procedures to ensure that residents are safeguarded from abuse in all its forms (though see the section on Staffing for our findings in respect of CRB checks on staff). And staff individually confirmed their commitment to challenge and report any incidents of abuse, should they occur. In the event, we were told this had not been warranted. We can confirm that no complaints or adult protection alerts have been raised with the Commission against this home since the last inspection. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained environment, which encourages freedom of movement as far as they are individually assessed able. Evidence: This single storey property was purpose built in 1982. It is situated in a quiet cul-desac (Manor House Gardens) off Crouch House Road, which is, in turn, just off Edenbridge High Street (with all the community and transport links, including two railway stations, that implies) - just 5 minutes walk away. The home also makes use of a minibus from Sevenoaks Volunteers to access community events. On-site parking facilities are good (something like 18 car parking spaces on site though we judged they could be better lit) and visitors could also use the access roads, where there are no restrictions. The home is set in attractively landscaped gardens each unit has its own secure garden area. And we were advised that since the last inspection visit, some exits and pathways had been pressure washed, repaired and repointed to improve access. The site has also benefited by some tree work. Measures are in place to keep the premises secure against unauthorised access, including an intercom system, external spot lights and an alarm system on external Care Homes for Older People Page 22 of 36 Evidence: doors. We were assured that residents could come and go freely, subject always to individual risk assessments, and we observed one taking her customary stroll. The layout of this home is judged generally suitable for its stated purpose. There is ramped access into the gardens, but the property is otherwise level throughout. All corridors and doorways are wide enough to allow the passage of wheelchairs and mobility aids. There is key-pad access between three units, but residents can move about freely in each unit as independently as they are assessed able. All areas are linked with a call bell system, to keep people safe. This home has six communal areas, including a sensory room in the Malek Unit, and a new large conservatory in the Tudor Unit. We were told that since the last inspection, new lounge chairs had been introduced into all the units and some curtains and carpets had been replaced. We were told that the colours in each unit were chosen by the residents. The furniture tends to be domestic and uniform in style and of good quality, and there were homely touches everywhere. Corridor ceilings have been replaced and the lighting in each corridor has been updated. As with other homes in the Abbeyfield group, some specialist provision is in place but it is not overly conspicuous and includes static and lever grab rails, raised toilet seats and toilet frames, special mattresses, discreet commodes and some lifting equipment. This list is not exhaustive, but we heard that storage can be a problem. This home has five communal bathrooms (including two adapted baths), a shower room and eleven communal WCs, all of which are judged reasonably close to bedrooms and communal areas, so that people can exercise some choice. Since the last inspection, these facilities have been refurbished - old WCs have been replaced, surfaces have been re-tiled, and flooring has been replaced. This home is currently registered to provide care for up to forty nine residents. Two bedrooms are designed to be double rooms but in practice all are used for single occupancy, which means health and personal care can be given in privacy. Four bedrooms have their own en-suite WCs and showers as well as wash hand basins. Four bedrooms, selected at random from the Windsor dementia unit, were inspected on this occasion, and judged well maintained and personalised. In terms of their furniture and fittings, moreover, they generally showed good compliance with all the provisions of the National Minimum Standards, accepting that the discreet commode could also double as the required second comfortable chair. But it wasnt always clear whether residents had been offered keys to their bedroom doors or lockable facilities. The reader is advised that non-provision must be justified by a properly documented Care Homes for Older People Page 23 of 36 Evidence: risk assessment or opt out consultation. All bedrooms are linked to a call bell system, to keep people safe. We judged the home safe and generally well maintained. With two exceptions (gas safety certificate and follow up fire safety audit by fire officers) all the maintenance records we looked for were on site, up to date and systematically arranged. Comfortable temperatures and lighting levels were being maintained throughout both visits, and the home was odour free in all areas inspected. We were told that odours and cleanliness were being better managed since new carpet shampooers were installed at each end of the home so as to be readily accessible to rooms and corridors. We were also advised that an extra bin had been set up outside to help keep the area clear of rubbish, and that attention was being paid to keeping fire exits clear. Comments about the home included, Couldnt fault it. Ive just had a lovely new carpet in my room. Very clean. Occasionally, the toilets could be cleaner. See section on Health and Personal Care for matters requiring attention in respect of the homes medication room. Care Homes for Older People Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff on duty each day in each unit may not be enough to reliably meet the aims of the home and the changing needs of the residents. Staff and residents benefit by the training investments in staff, but these will need to be ongoing to ensure expected practice standards are embedded. Evidence: This section of our inspection generated significant mixed messages from the people we consulted, and will require a concerted effort to obtain consistencies. This homes staffing arrangements are designed to ensure that (excluding the manager) one should expect to find: Stuart Unit (9 beds - elderly frail) - 1 carer from 7.30am till 2.30pm; and 1 carer from 2.30pm till 9.30pm Malek Unit (22 beds - elderly dementia) - 3-4 carers from 7.30am till 2.30pm; and 3-4 carers from 2.30pm till 8.30pm Windsor Unit (10 beds - elderly dementia) - 2 carers from 7.30am till 2.30pm; and 2 carers from 2.30pm till 9.30pm Tudor Unit (7 beds - dementia aged 50 upwards) - 2 carers from 7.30am till 2.30pm; and 2 carers from 2.30pm till 9.30pm. Care Homes for Older People Page 25 of 36 Evidence: There are two cooks who a kitchen assistant, who cover the week between them with shifts from 7.30am till 2.30pm. And there are five cleaning staff who work from 8am or 9am till 1pm or 2pm. One other domestic is also able to cover carers tasks on a flexible basis. At night there should always be 3-4 carers on waking duty, to cover the home from 9.30pm till 7.30am. There should, in addition, be one senior on duty each morning, and another on duty in the afternoons, who is also on site on call overnight. In the absence of the manager this arrangement should ensure that there is always someone in charge, with an oncall system as a back up, to keep people safe. In practice, this arrangement is subject to some flexibility on a day-to-day basis, largely intended to accommodate individual staff members personal commitments, though we judged it likely to cause some frustration too. For example, carers may actually be starting work at 7am, 7.30am or 9am, and their finishing times are adjusted pro rata. Two units are, moreover, connected (Tudor and Windsor) so that staff from one unit could be found covering shortfalls in the other e.g. for an hour or two at a time. The manager is able to call on an agency approved by Abbeyfield for cover, and tries to ensure these individuals are familiar with the home and its working practices to ensure some continuity of care. Team working was identified as a key strength by a number of sources, and feedback from some service users and their relatives indicated a generally sound level of satisfaction with staff care. We were told, the carers are wonderful. Nothing is ever too much trouble, that the home gives a generally good level of care and that staff did everything to make things comfortable for the people they care for. And we can confirm that no concerns have been raised with the Commission since the last inspection visit (September 2007) or, indeed, through the homes complaints procedure or meetings (unit based, staff group meetings or meetings with carers) about the homes capacity to maintain these staffing levels, except over weekends. We asked for staffing rotas for the month preceding our visits and found that these generally (with some isolated exceptions, which were explained by the manager) confirmed the arrangements as described. But we have received some critical comments about staffing levels in direct response to our visits this year. We were told carers should be able to slow down and spend more time doing their tasks, and one source said (there should be) more staff Care Homes for Older People Page 26 of 36 Evidence: preferably 3 at least on at a time. As if there is a problem with another resident often it takes two carers to deal with the situation and the remainder of residents are left unattended. Occasionally co-ordination between shifts goes a little dysfunctional. One healthcare professional told us, Physical care needs are well attended to. However psychological / occupational perhaps less so. This appears to relate to lack of staff to allow for one-to-one discussion, walks etc. Feedback from seven staff during our inspection visits was unanimous in alleging shortfalls in staffing levels. Examples of how this impacted on staff practice included unnecessarily long medication rounds, for want of assistance which could affect the effectiveness of medication; and having to take staff away to assist individuals needing interventions or two staff at a time (e.g. for toileting etc) leaving the other unattended. This will require positive leadership and practical interventions to regain the confidence of critics. Feedback from staff indicated that this home has a systematic recruitment process to comply with the key elements of the standard. And our assessment of personnel files generally confirmed that a range of checks were routinely being instigated to keep people safe. One notable exception to this was that while copies of applications for police checks were kept on file, their outcomes werent. Records confirmed feedback from staff that they receive a range of relevant training most notably dementia care (basic awareness and more advanced learning) as well as infection control; catheter care; food, fluid and nutrition awareness; pressure sore prevention; and the prevention of falls. Training in person-centred care has been commented on earlier in this report (see section on Health and Personal Care) as has the need to keep this regularly updated to ensure its principles are embedded in practice. Staff told us they feel well invested in, training wise. But see our findings on staff supervision and management support in section Management and Administration. The homes AQAA told us that 60 of staff have obtained NVQ accreditation, with another eight staff in prospect. Care Homes for Older People Page 27 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work needs to be done to promote a culture of openness and respect. Staff would benefit by regular formal documented supervision sessions to comply with all the provisions of this standard. Evidence: The Commissions registration process has established that the manager, Ruth Mills has the relevant training and experience for her role. The AQAA told us she has over 26 years experience in residential care for the elderly mentally infirm and physically frail. She also has accredited qualifications in dementia care, and is trained to give training in mental capacity issues. This list is not exhaustive. She has NVQ Level 4 accreditation in Health and Social Care, though her Registered Managers Award is still outstanding. There are clear lines of accountability within the home, and within Abbeyfield on a Care Homes for Older People Page 28 of 36 Evidence: wider level. Relatives and visiting professionals (health and social care) have indicated they have confidence in the manager and her team. But this inspection has told us that the homes management team will need to find ways to recover the staff groups confidence, which has been damaged by perceived shortfalls in staffing levels and managerial support. The homes AQAA told us that with one exception, all the current residents are white British. Nine are male - the rest are female. With two exceptions, all the staff team are currently female. One is Asian, and the rest are white British. We judge this largely reflective. Abbeyfield has formal annual business planning processes, which the home contributes to with projects. It does not have its own formal development plan as such. The home uses a range of feedback tools, such as large scale annual satisfaction surveys, and smaller themed feedback exercises. There are Unit meetings, meetings with residents relatives and staff group meetings. We looked at a selection of these. Outcomes included changes to menus, decisions about refurbishment and decor as well as activities and outings. This was judged promising, and should enable Abbeyfield to evaluate the homes performance against its stated aims and objectives and allow people to see how feedback can influence the way services are delivered. When we asked what Stangrove Lodge did well, one healthcare professional listed a number of attributes, which we judged generally fair and representative of our own findings: - Physical care (hygiene, appearance, food/fluid intake, medication) Environment (pleasant, clean, spacious) - Mostly appreciating individuality - Seek advice / support - Generally attempt to resolve concerns of the residents/ relatives Staff open about issues concerning them When we asked how Stangrove Lodge could improve, the same healthcare professional told us: - Psychological, social and occupational support / activity would need to be increased. These do not need to be in depth, but one-to-one discussion (daily), outings, walks, music etc. depending on individual needs, could well help to improve quality of life. - Training, hopefully standardised, including specifically in dementia may help reduce contrasts in care delivery. We judged this a useful summary of issues to take forward, in which further investments (staff and training) are quite properly implicated. Other examples are detailed throughout this report. Records indicated that compliance with the National Minimum Standard was, at best, Care Homes for Older People Page 29 of 36 Evidence: variable, in terms of the frequency of formal, documented staff supervision sessions (in some cases at least six or more months apart), and feedback from staff alleged it could be even less frequent. This was judged worrying as staff practice risks becoming variable without periodic checks and balances. And the manager risks losing the confidence of her workforce. With one exception (March), Abbeyfield has been able to evidence compliance with its duty to carry out formal documented inspection visits every month (Regulation 26) this year, but we were concerned to see that over the past twelve months, four such visits were not accounted for. The reader is advised that non-compliance with this regulation is an offence and is contributing to this homes overall quality rating. With two exceptions (reported on earlier in this report (see section on Environment) all the homes property maintenance certificates seen were up to date and systematically arranged to facilitate access. There are regular health and safety inspections around the home, to keep people safe. Care Homes for Older People Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18(1)(a) The registered person shall, 31/10/2007 having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that, sufficient staff must be working at the home at weekends. All units must have sufficient staff to ensure that the needs of residents can be met without undue delay. This requirement has been carried forward from the last inspection Manager asserted that shortfalls had been addressed and that some flexibility was available to her. Staffing not raised as an issue in unit meetings or complaints register. Manager asked to supply previous months staffing rotas. Some isolated shortfalls. Meetings with staff indicated there were ongoing shortfalls. Care Homes for Older People Page 31 of 36 Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The numbers and deployment of staff must always be capable of meeting emerging needs of residents without compromising the needs of others. Action plan to be submitted. To keep people safe 29/01/2016 2 33 8 Abbeyfield must demonstrate sustained compliance with its regulatory duty to carry out formal documented inspection visits at least once a month. To demonstrate fitness 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Combined Statement of Purpose and Service User Guide should be checked against the detailed provisions of Page 33 of 36 Care Homes for Older People this standard to ensure prospective service users and their representatives have all the information they need. 2 1 There should be a checklist to confirm the issue of the Statement of Purpose, Service User and contract, and whether other languages or formats were warranted, as evidence of this homes inclusive approach The contract should make pointed reference to the care plan so that service users can be aware of their provisions Investments in staff training in person-centred care planning should be maintained to ensure their principles are embedded in practice. The home should take the lead over periodic formal multidisciplinary care plan reviews, and these documents should evidence the participation of residents (where able and willing) and their representatives, whether familial or professional. Medication Room. The following matters are raised for attention / consideration to improve its capacity to withstand contamination: - Sink requires regular cleaning and should be free of an overflow aperture. Taps should be wrist/elbow operated. - Sharps bin should not be stored on window sill (wall mounting is preferable) and there should be a Sharps injury notice on display - Terracotta window ledge require sealing to obtain an impermeable easily cleaned surface - Ceiling should be capable of being easily cleaned The home should try to provide an activities co-ordinator to ensure recreational needs and meaningfuld activities are readily available to residents. The home should try to secure representation from religious denominations of choice for residents, to meet their spiritual needs. Catering staff should be given training on catering for people with dementia and other age related conditions. Complaints should be indexed and secured against loss or disarray. There should be better lighting around car parking facilities Locks on bedroom doors and lockable facilities. Non provision should be justified by properly documented risk assessments or opt out consultation. The manager should ensure that the latest gas safety certyificate and fire officers follow-up audit is available on site for anyone authorised to inspect them Page 34 of 36 3 4 2 7 5 7 6 9 7 12 8 12 9 10 11 12 15 16 19 24 13 26 Care Homes for Older People 14 32 The homes management team will need to find ways to recover the staff groups confidence, which has been damaged by perceived shortfalls in staffing levels and managerial support. Care staff should receive formal documented supervision sessions, to comply with all the provisions of this standards. 15 36 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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