Inspection on 12/06/07 for Abbeygate Care Centre

This inspection was carried out on 12th June 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

Abbeygate Care Centre 11/07/08

Abbeygate Care Centre 14/01/08

Abbeygate Care Centre 16/01/07

Abbeygate Care Centre 16/02/06

Abbeygate Care Centre 25/10/05

Abbeygate Care Centre 17/03/05

Abbeygate Care Centre 15/02/05

Abbeygate Care Centre 12/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Abbeygate Care Centre 2 Leys Road Brockmoor West Midlands DY5 3UR Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 12th June 2007 07:10 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 Abbeygate Care Centre DS0000025048.V336386.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. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeygate Care Centre Address 2 Leys Road Brockmoor West Midlands DY5 3UR 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) 01384 571295 F/P 01384 571295 Mr Dasrath Sahadew Mrs Hilary May Sahadew Mr Dasrath Sahadew Care Home 17 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (16), Physical disability over 65 years of age (1) Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include 16 OP and up to 1 MD(E) and 1 PD(E) Date of last inspection 16th January 2007 Brief Description of the Service: Abbeygate Care Centre is a detached building, with original parts of the house dating from 1845, situated in Brockmoor, which is to the west of Brierley Hill and close to the Merry Hill Shopping Centre. Sited in its own grounds, with mature gardens and car parking available, it has been adapted and extended for use as a Care Home for older people. Accommodation comprises 17 single bedrooms (8 with en-suite), plus two communal lounges, one of which includes a conservatory/dining area. A shaft lift provides access to the first floor. The Home is registered for the provision of personal care only, with any required nursing care being provided through local health services. The home is managed by one of the joint providers with a staff team consisting of a deputy, senior carers and care staff in addition to some ancillary staff. Fees vary between £353 and £398 and are dependant on the needs of the service user and the type of room that will be occupied. Items that are not covered by the fee include hairdressing, chiropody, toiletries and newspapers. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on one day by one inspector between 07.10 and 15.50 hours. A questionnaire was sent to the owner to complete prior to the inspection to gain information to use for the inspection and report. Questionnaires were also sent to relatives and service users’ to gain their view on the service provided. During the inspection I spoke with three staff and the deputy, three visitors and four service users’ to also gain their views on the service provided by the home. I spent a long time in the morning looking at records in the conservatory where I could observe staff and service user contact and daily routines. I looked at the premises which included three bedrooms, toilets and bathrooms, the lounges and conservatory area, laundry and kitchen. I partly observed both breakfast and lunch time. I looked at three service user files to assess their care plans, health records and general care. I looked at staff records to assess recruitment. No training records were available for me to look at. I looked at records and certificates concerning health and safety and quality assurance. What the service does well: The home has a nice atmosphere. It was welcoming and friendly. Staff observed were caring and friendly, polite and knew the service users’ well. It was evident from observations speaking to staff, service users’ and visitors that the home very much encourages those service users’ who can to do what they can for themselves such as walking. There was lots of written evidence to confirm adequate input from health care professionals this confirmed further by observation and by talking to service users’ and relatives. Visiting times are open and flexible. The home encourages service users’ to maintain contact with family and friends. There were no odours in the home. Positive comments were received about the home from both service users’ and staff which included the following; “ The home is a nice size. It is wonderful. it is light and airy”. “.. Is as happy as she could be anywhere else except in her own home”. “ No problems, thinking of signing myself in”! “ Happy and looked after”. “ I am happy here”. “ I am happy here, nothing I would like to improve. It’s very good, they look after you well”. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 6 “ I have been here for a long time. I find it very good. If I said anything was wrong I would be lying”. “ I know my mother is being well looked after. I don’t have to worry about her”. What has improved since the last inspection? What they could do better: Assessment of service users’ who have been in hospital must be undertaken before they return to the home to ensure that the home will be able to meet any new needs. Care plans need to be expanded and reviewed to ensure that they capture all needs and risks. Care plans must also include preferences such as; the rising and retiring times for each service user. Risk assessment processes must be put in place for all service users’ for areas such as; tissue viability, nutrition and. accident prevention . Tools needed to ensure that these risk processes can be put into operation safely must be in place an example being; sit on scales . Medication safety needs to be improved further to include internal audits. Complaints procedures need to be updated, staff must receive training in abuse awareness. The premises are ‘tired’ and need some redecoration and replacement to make them brighter and more attractive. Infection control processes must be improved to prevent any risk to service users. Staffing levels are not always adequate to meet the demands of the service and the needs of service users’. During the inspection there were no records available to evidence the following; Staff supervision, staff training or quality monitoring. Hazards to safety were identified in the home which, need attention for example; there is a stainless steel flue in the laundry which gets extremely hot yet there is no restriction to access to this room. Some carpets on the ground floor need stretching to prevent tripping and the one by the ground floor toilet is frayed at the threshold. These issues need urgent attention as they potentially place service users’ at risk. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 7 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. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 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 Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is adequate. The home’s readmission processes from hospital leave a lot to be desired in terms of written documents however, generally speaking both service users’ and relatives confirmed that they were satisfied with information available before their admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at three service user files and did not see evidence to confirm that a terms and conditions had been issued which means service users’ are not all officially informed of their rights as a ‘resident’ or how much the placement will cost. The deputy told me; “these are being sorted out, people who have been here for some time have not got a terms and conditions yet but this is being worked on”. What the deputy told me was confirmed by feedback from completed questionnaires as 5 of 9 confirmed that they have got a contract but 3 commented, that they have not got a contract, 1 chose not to answer Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 10 this question. The deputy was able to provide me with an updated list of fees for the financial year 2007/2008 which can be shown to prospective service users’ and their families to inform them of how much a placement would cost. Assessment of need processes vary. Written evidence of assessment was available for new service users’ which is positive as this shows that the home gives some consideration of individual needs against their ability to meet these needs. I was concerned however, that there had been no reassessment of need for one service user before she had returned from hospital in February 2007. A document I saw from the hospital said; “ .. is a two hoist transfer. Since speaking to staff at Abbeygate we were informed that you would be happy to have her back without assessment”. As the home does not have a hoist and did not reassess this persons changed needs it would not of been possible for them at that time to confirm that they could meet this persons needs which could have placed them at risk. It was positive however, that two of the three service user files I saw had written evidence to confirm that they had been reviewed by social workers from their funding authorities, one in 4.07 and one in 10.06 demonstrating that external agencies are monitoring to see these service users needs are being met and that they are safe. Comment for one was “ No concerns”. The other “.. told me that she was happy with the care she receives from staff at Abbeygate . No concerns”. Our completed service user questionnaire confirmed that 7 of 8 service users’ felt that they were given enough information prior to their admission to allow them to make a decision about the homes’ suitability, 1 said no and 1 did not answer. 9 of 12 relatives also confirmed that they had been given enough information. Comments received about admission processes included the following; “ We made a good many visits to homes’ in the area before making any choice. We visited here first then took.. to see how she felt”. “ My daughters inspected many homes before taking me to see Abbeygate”. “ This was the only home where we did not have to make an appointment. We came and they showed us around”. “ Came to have a look before I came in”. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. Care plans need improvement to ensure that all needs and risks are captured. Some improvements are needed to ensure that in-house monitoring of risk is undertaken with greater attention and increased frequency. People who use services have access to health care services both within the home and in the community. People who use services unable to access local services are managed by visits to the home by health care professionals. Staff very much encourage those who can, to stand and walk. Staff acknowledge the need for medication safety but further improvements are needed to ensure full safety. Staff encourage service users’ who can, to be independent where they can, for their own personal hygiene needs. This judgement has been made using available evidence including a visit to this service. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 12 EVIDENCE: I looked at 3 service user files saw that a care plan was in place for each. However, these were of a poor quality in terms of information being missed, the level of instruction for staff and the lack of service user/chosen other involvement. One care plan I looked at for someone recently readmitted from hospital did not capture her high dependency needs or needs, that could have caused a risk an examples being; lack of a hoist for moving needs. And swallowing difficulties which was confirmed by a written letter; “ Swallowing ability improved.. the signs to be made aware of have been discussed verbally and have been reiterated with additional written information. This information however, was not detailed in any care plan which could potentially place the service user at risk. For another service user who has depression the care plan said” suffers from depression- to enjoy life to the full. Encourage to be happy and contented and to be reassured at all times”. It did not detail any triggers for this depression, what the signs and symptoms would be or what to do if they were identified. The deputy told me; “ I know that work is needed on care plans”. There was no evidence on file to confirm that service users are involved in their care planning processes preventing them from having the opportunity to make their views known. I was concerned to see from records that a number of service users have lost weight and that for all but one, there was no evidence to confirm that concerns about weight loss had been passed on to their doctor or detailed in their care plans. Further, the home does not have a set of sit on scales to weigh service users. The staff told me ,,” Can stand and be weighed using her frame”. This practice could be unsafe and give incorrect readings. There were no visual monitoring processes in place either, for service users who due to their illness could not be weighed by any means. The deputy manager told me; “ We have not got sit on scales. We have now got nutritional assessments but not all service users’ have had an assessment done, this is being worked on”. She was able to provide one completed nutritional assessment which, indicated concern and gave instruction for referral. This instruction had been carried out. The doctor had assessed and prescribed a nutritional drink and evidence available suggested that this service users;’ weight is now more static which is positive as the risk to this persons health has now decreased . The deputy also told me that tissue viability assessments are not in use in the home. These should be in place to identify any concern and prevent tissue damage. I did however, see evidence to confirm that the district nurse is informed when tissue damage occurs and that where needed, as in the case of the service user re-admitted back from hospital specialist mattresses, are provided and regimes such as regular turning are in place. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 13 I found it extremely positive to see written records on each service user file to confirm in put from a range of professional healthcare services examples as follows; podiatrist visit to one service user 10.4.07. Speech and language therapist came to see another service user on 15.3.07 and chiropodist visits on 11.10.06 and 16.1.07. That healthcare services are accessed regularly was confirmed by service users’, staff and relatives spoken to comments included the following; “ Oh yes, Dr Spencer is coming today”. “All have the doctor, chiropodist and dentist”. “If someone is poorly the doctor is called right away”. “ See chiropodist. I’ve been to the hospital for an appointment recently”. I also found it very positive to see throughout the day staff encouraging service users’ to stand and walk. They were encouraged to use aids available to walk, rather than them being pushed in wheelchairs. This is good practice to ensure muscle tone and to maintain mobility. People spoken to confirmed that exercise is encouraged at all times. One staff member said; “ We try everything to help them to exercise, by walking and standing. We put the music on to get them to move around”. One relative said; “ They do encourage them to walk “ and a service user said; I walk with my frame”. I observed good practice in the morning, the night senior giving a full report to the deputy about what sort of night each service user had had, any changes or concerns about individuals conditions and any appointments for that day. I did not look at the homes’ medication policy during this inspection. I did see that a past requirement for a controlled drugs book to be put into use has been met. Controlled drugs are stored in a lockable cupboard, but not a cupboard, which meets Royal Pharmaceutical of Great Britain guidelines to increase medication safety consideration, should be given to purchasing the correct cupboard. Staff spoken to told me that they have received medication training unfortunately this could not be further confirmed as no medication certificates or training matrix were available for me to view as they should have been. The home does not use a monitored dosage system. Medication is administered from packets and bottles. Each service user has their own named plastic box to store their medication items in which means that, medication systems are relatively organised to increase safety of medication. A photo was available by the medication record for the majority of service users, ’but not all. This needs to be addressed to ensure correct identification and error prevention. I observed the member of staff giving out the medications signing medication records before giving the medication to the service user which is incorrect as the medication should only be signed once the staff member is sure that the medication has actually been taken by the service user. I saw that totals of medication are not being carried over when new stock is delivered which means that medication audits can not be carried out effectively. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 14 I heard the night staff member telling the deputy what the blood sugar levels were for two service users’. I was concerned however, that there was no evidence available to confirm that staff have received training and have been deemed competent to carryout this task by a qualified person. There were no care plans for medication. Which means that staff are not being provided with up to date instruction about individual service users’ medication such as when ‘As needed ‘ medications should be given. Internal audits of medication are not being carried out to increase medication system safety and prevent early identification of problems. It was evident that staff where possible do try to encourage those who can to do what they can for themselves. I saw one service user feeding herself although staff kept a close eye on her to make sure she was safe. I saw staff encouraging service users’ to walk. One service user said to me; “ They like you to try and do things for yourself”. A staff member said; “ We believe in encouraging independence for instance where people can walk and wash”. A relative made the following comment; “ They always encourage them to be independent, to do things for themselves, but are always there if needed”. I observed staff throughout the day they were polite to service users and relatives. They gave service users’ choices. One relative commented; “ we were treated with respect first visit”. “ They treat Mum as an individual to me this is vital”. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 15 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 adequate. Evidence is weak to demonstrate that all service users’ can get up at a time of their choosing. Activity provision should be improved upon to ensure that each service user is offered the opportunity to take part in meaningful activities to increase stimulation. Visiting times are open and flexible. The home encourages service users to maintain contact with family and friends. The home puts processes in place to help increase service users’ rights. Although some work is needed, generally meals provided by the home are to the satisfaction of the service users’ and are nutritious. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I was surprised when I went into the lounge at 07.30 to see twelve service users’ up and dressed. I was told that; “ Breakfast is at 8 o’clock and encouragement is given to get up for breakfast”. I did not see any reference to preferred rising times in care plans as there should be to demonstrate that rising times revolve around service user needs rather than the needs or Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 16 routines of the home. I explored this further by speaking to service users’ and relatives and was told the following; “ She gets up early. Not a problem, she gets herself up that’s what she wants”. “ I get up at 6am, I don’t like to stay in bed”. “ I get up at 6, always did at home”. “ Everyone up for 8”. One staff member said; “ Breakfast is around 8 o’clock but we always ask. We would not make anyone get up who did not want to”. Whilst it is clear a number of service users’ want to get up early, others may not. To ensure that this issue is resolved the preferences of all service users’ must be sought and appropriate action taken to ensure full satisfaction with rising times and breakfast time for all. It was evident that staff do try to do their best concerning activities. For instance whilst sitting in another area I heard a staff member asking service users what the day was, what the date was and what they would like to do. She told them; “ If its nice later we can go in the garden”. Later on a staff member put music on and service users’ were encouraged to move around after one service user told me; “ We have had a lovely afternoon singing”. Feedback from service user questionnaires about activities showed the following; 5 of 9 confirmed that there were always activities arranged by the home that they could take part in, 2 of 9 usually and 1 never, 1 did not answer. Comments received about activity provision included the following; “ We have quizzes, sing songs and games”. “ Always something going on like music, games and bingo”. “ Could do with more activities”. “ Not enough stimulation of the mind”. “ Can try to have more activities”. “When I am here they have activities, sometimes I read the newspaper to them. Sometimes they have live entertainment”. It is therefore clear that some activities are provided and staff do try. But not all service users are satisfied with this so, work is needed to find out the needs of each service user and provide activities around these individual needs. I saw a sign in the entrance hall confirming open visiting, but for people to be mindful of meal times. All service users I spoke to told me that they have family and visitors on a regular basis as follows; “ I have a son, daughter in law and grandchildren who all come to see me”. “ My family come a lot everyday”. “ My daughter comes and sees me and takes me out”. Relatives I spoke to told me; “ All of our family come, someone every day. My brother comes six days a week and stays between 2 and 6pm everyday”. “Always welcomed. I can come at anytime. Always offer me a drink”. I saw on service user files letters from the local council to confirm that they have been included on the voting list which is positive as it shows that the home ensures that service users’ can vote if they wish. Every bedroom I looked at held a varied and number of service users personal belongings to make their rooms feel homely and personalised. A relative made Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 17 the following comment; “ The rooms are really nice and the residents can take their own possessions from their own home which helps the settling process”. Feedback from completed service user questionnaires about meals showed the following; 5 of 9 always like the meals, 2 usually and 1 sometimes. I looked at the homes’ menu and saw that this was produced only in writing and only detailed lunch and tea. It did not mention breakfast or supper. The lunch menu only detailed one meal. It did sat ‘ alternative,’ but did not say what this was. Which means that service users are not fully informed before hand what food is available for each meal. Breakfast consisted of cereals or toast. The lunch cheese and potato pie, tinned tomatoes and baked beans which, is fairly nutritious. Staff were on hand at lunch time to give assistance. It was clear that all staff knew the one service user who tends not to each much. I heard them encouraging her both at breakfast and lunchtime to eat. When I looked in the kitchen I saw that food stocks were adequate and was pleased to see plenty of fresh salad, fruit and vegetables. One relative told me; “ She likes her fresh fruit”- pointing to a dish of oranges- “ They buy her the fruit”. When I asked service users’ about meals they gave me the following responses; “ The food is very good. Everything is well cooked, can’t fault it”. “The food is very good”. “I have what’s put in front of me and enjoy it”! “ The food is alright”. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 18 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 . Whilst most service users’ and relatives know how to make a complaint three did not. The complaints procedure and recording systems are not up to date. Complaints procedures are not available in any format other than writing. Some staff have had training around safeguarding adults but others have not. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints or allegations or incidents of abuse have been reported or are known concerning this home. Completed service user and relative questionnaires showed the following; Service users’- 8 of 9 confirmed that they know who to speak to if they are not happy, 1 did not answer this question. 6 of 9 confirmed that they know always know how to make a complaint 2 answered no to this question and 1 did not answer. Relatives- 11 of 12 confirmed that they know how to make a complaint 1 answered no to this question. The owners completed annual quality assurance assessment says; “ We have a complaints policy predominately displayed at the home”. I found this to be correct. The policy was on display in the hallway. However, it was not fully up to date as the named point of contact for the Commission on the procedure has not worked for the Commission for over 18 months. Further, complaint Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 19 logging systems were considerably out of date as they related to the homes’ previous name ‘ The Old Vicarage’ rather then the new name ‘Abbeygate’. A number of staff were asked about abuse awareness training. Most said they have not received this training. This demonstrating that a previous requirement for the lack of protection training to be addressed by 31/3/07 has not been met. Further, no staff training certificates was available as they should have been for me to look at. It was positive however, that staff spoken to knew about Dudley Councils protection procedures’ which gives them instruction of what to do if an incident or allegation of abuse were to occur. I asked staff and relatives if they have ever seen anything concerning in the home and gave examples of shouting, hitting or rough handling by staff or incidents between service users’ the following answers were given; “ No I have no concerns as far as staff and residents are concerned. Sometimes residents hit us”. “ Some staff may be a bit loud, not nasty, just loud”. “No”. “ I have no concerns. Someone comes everyday. We have not seen or heard anything”. “None- I have never seen anything concerning”. These answers indicate that service users’ are not being placed at risk of harm, which is positive. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 20 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): 19,24,25,26. Quality in this outcome area is adequate . The home provides a physical environment that is homely and comfortable. It allows service users’ to personalise their rooms. However, it does have a number of redecoration needs. Infection control processes are weak and need improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has some redecorating needs. In areas such as corridors and landings paintwork is chipped and has seen better days. Whilst it is evidenced that work has been done such as two requirements met from the previous inspection for the lounge ceiling to be repainted and the broken glass replaced in the French doors there is still plenty to do. This confirmed somewhat by the owner is his annual quality assurance assessment; “ We could speed up maintenance and renewal programmes resources permitting”. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 21 The home offers fairly generous communal space. There is a lounge dining room, conservatory and an additional smaller lounge. Lounge areas are homely with pictures on the walls, a nice clock, an attractive feature fireplace in the small lounge and flowers and plants. One service user said; “ I like the small lounge. I like to have time on my own and they let me do that”. A relative said; “ The home is a nice size”. I looked at four service user bedrooms. One service user’ told me; “ Nice bedroom, clean bed ”. I saw that radiators in the home are guarded. The only one that is not is the one in the hall. The deputy told me; “ That is because the fire doors would not shut properly if a guard was on. It is not turned on so there is no risk”. I did not detect any offensive odour in the home. Generally, the home looked clean and tidy which is positive. Service users and relatives made the following comments about the home cleanliness; “ Yes the home is very clean and always presentable to family’s who attend”. “ First thing my daughter observed on initial visit was there was no smell of urine, rooms clean and fresh bed linen”. “Keeps care home clean and homely”. “ Very clean”. Infection control processes were of a concern. I looked at the laundry. The floor was dirty and it was very dusty. There were material garments behind the dryer on the floor, which must have been there for some time as they were dry, very creased and were covered in dust. A past requirement, which should have been met by 28/2/07 concerning the permeability and state of laundry walls, remains outstanding. The laundry only has one sink which does not allow choice if service users’ want delicate garments hand washed. There were no infection control procedures in the laundry for staff to reference to prevent infection transmission. In bathrooms and toilets I saw bars of soap. Although soap dispensers were on the walls they were empty. I saw a material towel in the ground floor toilet, no disposable towels were available in this room to prevent infection spread. There were no disposable gloves or aprons on the first floor. I saw communal items in bathrooms such as a razor, a jug and sponges, if used between service users’ these could spread any infection. Disposable gloves were of a thin ‘polythene’ type which can come off hands easily or rip, not providing staff adequate protection when cleaning faeces or body fluids. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 22 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 adequate. Staffing numbers provided may not always adequate and need to be reviewed. There was no evidence available in terms of staffing matrix or training certificates as there should be to be able to make a full judgement on NVQ and induction attainment. Shortfalls in recruitment practices identified potentially placing service users’ at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments were made by a range of different people about staffing levels as follows; “ Enough staff”. “ To me not enough staff”. “Sometimes only two staff in the mornings”. “ I think there is enough staff”. “ They could do with a help”. Two staff in the mornings is low as the staff have to meet the needs of the service users , administer medications and do the breakfast as well as carrying out laundry tasks. I sat in the dining room conservatory area during the morning and there were times when, there were no staff available. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 23 I observed one service user wandering a lot and needing reassurance. Once or twice there were no staff around to give reassurance. Another service users mental health has deteriorated and another one has high dependency needs and is cared for in bed. The service users’ may be at less risk if a third person was provided each morning. I was surprised when I read the statement made by the owner in his annual quality assurance assessment under the heading ‘ What we do well’ “Appropriate level of staff “ as when I looked at the rotas it was clear that this is not the case. Two staff were working nights then starting a shift the next day at 5PM, not leaving enough rest time between shifts. I asked the senior finishing off her night shift on the morning of the 12 June 2007 to confirm what I had seen on the rota, that she was coming back on shift later. She confirmed that this was the case. It is concerning that this staff member is a senior who is expected to be responsible for the shift and give medications whilst not being adequately rested. I observed staff during the inspection. They were kind and polite to the people in their care. By speaking to them it was clear that they had a good knowledge about the people in their care and were committed to providing a good standard of care. I received comments about the staff from completed questionnaires and by speaking to people which included the following; “ They are kind”. “ They look after us and S is very nice”. “ Most have hearts of gold. One or two would question if in right job”. “ Friendly crowd”. “ Staff really pleasant”. The owner provided stated in his completed annual quality assurance assessment that 50 of the staff have NVQ. As not all staff were to duty to ask during the inspection and there were no training certificates available or training matrix it was not possible for me to confirm this. The same applies to induction training. The deputy gave me the files of the newest staff to be employed which went back to 2006. I looked at these files and saw that there were a number of issues. One was that one staff member only had one written reference instead of the required two .This one reference was not completely satisfactory and should have been explored further. Another staff members references were to ‘whom it may concern’ and ‘dear sir or madam’ not giving assurance that they has been provided by authentic methods. One staff member had declared a health issue but there was no evidence to suggest that this had been explored further, or a risk assessment carried out. These issues show shortfalls in recruitment practices, could place service users’ at risk. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 24 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): 31,33,35,36,38. Quality in this outcome area is poor. The manager is also the owner and has the necessary qualifications and experience to run the home. Further development of quality assurance systems and a system to self assess the home is needed to ensure that the home is run in the best in the best interests of the service users’. Health and safety and risk assessment/ prevention processes need improvement in a number of areas as they place service users’ at risk. This judgement has been made using available evidence including a visit to this service. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 25 EVIDENCE: The owner is also the manager. He was on holiday at the time of the inspection so was not involved. The deputy was involved . She was helpful, friendly and confident. She was able to provide me with most things I asked for but not all such as information about the development of some processes such as when tissue viability assessments will be put into practice, evidence of quality monitoring processes and staff training certificates and information. The manager told me that she is in charge of the home lot but the manager does come into the home most days for a number of hours. She told me that she does feel supported by the manager, especially for advice. The owner has also got another care home therefore; having responsibility for two homes. If it is that the deputy is in charge of the home frequently for whatever reason and the owner/ registered managers input into the home has decreased then consideration about a full time manager may be needed. I saw that the home has the Mulberry House Quality assurance system. I did not see evidence that this has been used for self- assessment or quality auditing to date. The deputy could not provide any more information about the system or evidence of questionnaire usage. I checked three service user monies held in safe keeping. These are kept secure under lock and key. Each service user money is held separately. I looked at balances and checked these against money and found these to be correct. Receipts were available to confirm services from the hairdresser. Processes in place show that service user money is kept safe. An outstanding requirement remains concerning personal possessions brought into the home by service users’. To date the work needed to up date these documents has not been carried out. I looked at records and spoke to staff about their one to one supervision sessions. I did not see supervision records on the files viewed and staff were a bit uncertain if they receive supervision or not. That supervisions are not being carried out to the required frequency was highlighted in the annual quality assurance assessment carried out by the owner he said; “ We could improve on the frequency of staff supervision”. The owner wrote in his annual quality assurance assessment; “ We comply with all health and safety legislation..” I was therefore surprised to see a number of issues concerning health and safety which need attention to make sure that service users’ are safe. I was unable to look at staff training to date as neither a training matrix nor training certificates were available. This includes fire training and fire drill training which, were the subject of a requirement made following the last inspection in January 2007. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 26 I saw a boiler in the laundry that has a stainless steel flue which was extremely hot to touch. Similarly an urn is used in the kitchen for boiling water. Neither of the doors to these rooms had anything to restrict access, leaving service users’ at risk from burns and scalding. The last service certificate for the Apollo bath was dated 11/06, all equipment that moves people of the floor should be serviced every six months to make sure that it is safe. There was a lack of ventilation in the laundry. The room was extremely hot. I saw that the radiator guard in the ground floor toilet was not secure. If a service user used this for support it may cause them to fall. Bedroom 3- the wardrobe is not secured. There is a gap down one side of bedroom 3 door, a high risk as the service user who occupies this room is allowed to smoke in her bedroom. The risk assessment for the service user who smokes in the bedroom is not adequate. The person is not often supervised when smoking in the bedroom. Risk assessment -22.10.06 revised ( first risk assessment in place 2002) “.. smokes in room. May accidentally drop cigarette on carpet..” There was no evidence to confirm that advice had been sought from the fire service about service users’ smoking in their room or from the homes insurance company. The deputy confirmed that she was not aware if these persons had been asked to advise. This issue is concerning as it presents a risk to the whole home and the service users who live in it. I highlighted all these concerns to the deputy who had been given responsibility for the home in the absence of the manager. Another major concern that I identified which could place service users’ at risk of tripping were the carpets . The carpet in ground floor corridor areas needs replacing or stretching as it does not fit properly and is uneven. I saw that the carpet to the threshold of the ground floor toilet door was badly frayed. I highlighted these concerns to the deputy during the inspection. A requirement was made following the previous inspection for a hole in the carpet at the top of the stairs to be repaired by 31/3/07 to date this requirement has not been met. I saw that the hole was still there. I saw exposed copper piping in the ground floor toilet which needs to be covered as it got hot when I turned the tap on and is a potential burning hazard to service users’. I looked in the kitchen and found that a number of issues raised in the last Environmental Health report remain outstanding. For instance I saw the cook using a tea towel to dry up with although it had been highlighted in the report that disposable paper should be used. Hazard identification in the kitchen was lacking. Whilst there was temperature recordings for the freezers they did not identify which one the two freezers the temperatures were relating to. There was no evidence of food delivery temperatures or temperatures of food brought into the home after shopping. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 27 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 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x 2 3 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 1 Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 28 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) Requirement A full assessment must be carried out for all service users’ before they are readmitted from hospital. This requirement has been made to make sure that the home can meet the needs of all service users’ in the home and keep them safe. Care plans; Must contain all special instructions given by other professionals. Must contain enough detail to instruct staff what to do and what out look out for. Must be thoroughly reviewed regularly. Must evidence that the service user has been involved in its production. These requirements have been made to ensure that the needs of the service users’ can be met Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 29 Timescale for action 12/07/07 2 OP7 15(1) 12/07/07 and to keep them safe. 3 OP18 13(6) Staff must have training in the 01/09/07 protection of vulnerable adults. This requirement should have been addressed by 31/3/07 This requirement has been made to prevent harm or risk of abuse to service users’ and keep them safe. Staff must be able to effectively 02/07/07 wash their hands and liquid soap and paper towels must be available throughout the home where staff need to wash their hands. This requirement should have been addressed by 31/01/07. This requirement has been made to reduce the risk of infection transmission in the home and keep service users’ safe. 4 OP26 13(3) 5 OP26 13(3) The laundry walls and floor must 12/07/07 be impermeable and easily cleanable. This requirement should have been addressed by 28/02/07 This requirement has been made to ensure that the risk of infection within the home is minimal to keep service users’ safe. Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 30 6 OP27 18(1) Three care staff must be provided during the morning shifts ( until lunch ) at least. Adequate staffing numbers must be employed to prevent staff having to work a night shift and an evening the same day as the night shift ends to ensure that service users are safe. 02/07/07 7 OP29 19 All staff must have two written 12/07/07 references . This requirement should have been addressed by 31/01/07. This requirement has been made to prevent harm to service users and keep them safe. 8 OP38 13(4)( c) There should be clear written 12/07/07 directions in place in the form of moving and handling risk assessment for any service user that requires the use of aids ( i.e bath hoists). Further advice should be sought from Environmental services. This requirement should have been addressed by 31/3/06 This requirement has been made to prevent risk of injury to service users’ and keep them safe. 9 OP38 13(4)( c) All staff must receive two fire 12/07/07 drills annually. This requirement should have been addressed by 31/03/07 This requirement has been made to prevent risk to service users’ Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 31 and keep them safe. 10 OP38 13(4)( c) The registered proprietor must have a training plan that ensures that all staff receive required, statutory training, development and induction training. This requirement should have been met by 31/03/07 This requirement has been made to ensure that staff are adequately trained to ensure the safety of service users’. 11 OP19 13(4)( c) The maintenance programme 26/06/07 addresses the hole in the carpet at the top of the main staircase. This requirement should have been addressed by 31/3/07. Repair or replacement the hall carpet where it is fraying by the toilet room door. These requirements have been made to prevent risk to service users’ and keep them safe. 13 OP38 13(4) (c ) Access to the kitchen and laundry need to be restricted. A certificate to evidence the servicing of the boiler in the laundry must be available at all times. Advice must be sought from the fire service and the homes insurance company about the risk of fire from the service user who smokes in the bedroom room. All wardrobes must be suitably secured. 26/06/07 12/07/07 Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 32 All lifting equipment must be serviced every 6 months. All requirements contained within the homes last Environmental Health report must be addressed. These requirements have been made to prevent risks to service users and keep them safe. 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 OP8 Good Practice Recommendations Nutritional and tissue viability assessment processes should be in place and carried out at suitable intervals according to guidance. The home has a separate medication fridge. The temperature is taken and recorded of the room where medication is stored. The number of tablets left each month and then carried forward for use in the following month is recorded. Two members of staff must sign to confirm that the handwritten record of medication required is correct. A care plan for medications including one for medications prescribed on an ‘as needed’ basis will ensure medication processes are safer and prevent risk to service users’. Evidence must be available to confirm that staff who carry out blood sugar monitoring have been deemed competent by a district nurse. DS0000025048.V336386.R01.S.doc Version 5.2 Page 33 2 3 4 5 6 7 OP9 OP9 OP9 OP9 OP9 OP9 Abbeygate Care Centre 8 OP15 A review of residents choices regarding food and provision of breakfast is undertaken. Menus should detail four meals a day breakfast, lunch, tea and supper to make sure that service users know that these four meals are available each day. A cleaning schedule is available which covers the laundry and toilets. Suitable disposable gloves are available within the home. Suitable disposable bags are used for the washing of soiled clothing and linen. Communal items ( bath sponges, bar soap) are not available in bathrooms and toilets. 9 OP26 10 OP29 References are not accepted when they are addressed to to whom they may concern and there is no evidence that they have been solicited by the home. All staff must receive comprehensive induction that is recorded and meets Skills for Care standards. No evidence available at time of inspection. The manager/ owner must inform the CSCI of his intentions regarding the management arrangements for the home. A report must be available that summarises the findings of service user survey which can be shared with all interested parties. This requirement should have been addressed by 31.3.07 Staff must receive regular and required supervision that is recorded. A matrix is available of all dates that staff receive supervision. 11 OP30 12 OP31 13 OP35 14 OP36 Abbeygate Care Centre DS0000025048.V336386.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection CSCI – Halesowen LO West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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. 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