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Inspection on 18/03/09 for Abbeygate Residential Home

Also see our care home review for Abbeygate Residential Home for more information

This inspection was carried out on 18th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbeygate Residential Home 42 Quarry Road Winchester Hampshire SO23 0JS     The quality rating for this care home is:   two star good 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: Kathryn Emmons     Date: 1 8 0 3 2 0 0 9 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 25 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 25 Information about the care home Name of care home: Address: Abbeygate Residential Home 42 Quarry Road Winchester Hampshire SO23 0JS 01962855056 01962856910 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avonpark Care Centre Limited care home 30 Number of places (if applicable): Under 65 Over 65 0 0 30 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 30 30 0 The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary car needs on admission to the home are within the following category: Dementia(DE) Mental disorder,excluding learning disability or dementia(MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Abbeygate is a large care home on the outskirts of Winchester and is part of the Avonpark Care Centre Ltd. group of homes. The home is registered to provide personal care for 30 older people. Four of the beds are registered for dementia and or mental health care provision. The home is located in a quiet, residential, area of Winchester, not far from the city Care Homes for Older People Page 4 of 25 3 0 0 9 2 0 0 8 Brief description of the care home centre and amenities. The home is surrounded by a large mature garden, which is not overlooked. Sufficient parking is available on the premises; there is a steep incline from the car park to the front door of the home but there are also steps from the car park to the side of the house. At the time of our visit the weekly fees ranged form #347 pounds to #550 pounds per week. Care Homes for Older People Page 5 of 25 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: two star good 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 visit to the service was undertaken by one inspector who spent six and a half hours at the home. The care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records a range of general records and staff details. This forms part of a key inspection and focused on the standards in the key areas that most effect the quality of life for the residents. Information already held such as a service history and the providers self -audit which is called an AQAA (Annual Quality Assessment Audit) were used to plan the visit. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? 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 7 of 25 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 8 of 25 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. A pre admission assessment means that residents can be confident that they will receive a service which meets their needs. This is further upheld by them receiving a contact which upholds their rights to except that service. Service user guide updates mean that people can be confident the information they are given is current. Evidence: The manager confirmed that all prospective new residents were assessed by someone senior from the home before an offer of admission was made. We looked at records for the last person to be admitted to the service . We saw that an assessment had been completed by the head of care and also information from the hospital staff had also been obtained. We saw that after the resident was admitted to the home they were given a copy of the services contract. This means that residents can be confident that the service staff are aware of their needs before they are admitted to the home and agree to meet Care Homes for Older People Page 9 of 25 Evidence: those needs. There are two documents in place which help people make decisions regarding living at the service. These are called the statement of purpose and the service users guide. Both of these documents include information such as accommodation provided and details of the staff and the services provided.The manager confirmed she updates these documents when necessary. The AQAA we received recorded a recent date for these having been updated. Care Homes for Older People Page 10 of 25 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. The new care plan format and subsequent reviews ensure residents current needs are known and changes made when necessary. Medication arrangements are good and decisions around giving when necessary medication are clear. Residents are supported in a dignified manner and they are spoken to appropriately. Resident are satisfied with access to heath care professionals. Evidence: Since the last inspection a lot of work has been carried out with care plans. An initial assessment is undertaken and then an individualised care plan is produced for each need. We could see that these were handwritten and personalised and were reviewed each months with the resident where possible. We spoke to two relatives who said they were aware of the care plans for their relative. Two residents we spoke with said they were aware of their care plans and one said I sat with (staff) and we had a chat about me . When the care plans were reviewed and there was a change this was dated and the care plan was amended . We saw examples of this such as a change in a residents continence needs and another for bedtime support. There were standard Care Homes for Older People Page 11 of 25 Evidence: documents such as property list ,weight and nutrition charts and details regarding resident preferred hobbies and pastimes. We spoke with residents regarding their access to doctors and other health care professionals. We were told generally residents were satisfied and one relative said the manager will call a GP right away and i know that they are very good if people become unwell and from a resident Im happy with how I get my eyes checked and the doctor is often here.The manager confirmed that appointments can be made to see dentists and opticians and support is provided for residents to attend appointments out of the home if they do not want to see the visiting optician. A chiropodist visits the home ever five weeks and this is service which residents can purchase. We looked at the medication charts for all of the residents. We could see a good audit trial of all medication that was ordered and what was administered or returned to the pharmacy. Since the last inspection a care plan has been written for all medication that is perscribed as given when necessary. This means that all staff are following the same guidelines for administering and there is also a clear record of the change in a resident heath care needs which assists with doctor referrals. All resident are assessed on admission to see if they can look after their own medications and these assessments are reviewed regularly. One staff member is responsible for ordering all medication to ensure consistency. Staff confirmed they had received training in medication administration. We observed many interactions between staff and residents. These were appropriate and residents were addressed by the name they preferred. Resident said the staff speak to you in a very kind way and I overhear the staff speaking and they are always very nice. Staff were seen to be knocking on toilet doors before entering to support residents. At lunch time discreet assistance was giving in taking lunch for a few residents. Relatives we spoke with said they felt that staff had a very good attitude towards residents and were always kind and gentle with their work. Care Homes for Older People Page 12 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have control over their lives and are satisfied with the activities that are provided. Visitors are welcome at the service and residents can chose when to receive visitors. Catering arrangements are good and residents have their preferences catered for. Evidence: during our visit we saw two residents go to the local pub and another resident was sitting out in the garden reading a book. We saw a stock of large print books which are regularly changed. An activities programme was on display and residents we spoke with said they were happy with the activities available and were hoping that a few trips out would be arranged in warmer weather. We saw residents engaging in various activities during the visit . Some were watching television , reading books and chatting in small groups . We saw that a bingo afternoon had been planned and residents said they could spend their days how they chose. Residents told us they could have visitors when they wanted and were able to use one of the lounges to meet in private. We saw that visitors were able to attend the home at any time and the manager would always speak with visitors. Two relatives we spoke Care Homes for Older People Page 13 of 25 Evidence: to said they were always made to feel welcome. Residents we spoke with said they very much enjoyed the food they received at the service . We were told by residents that they always had a choice at each meal time and could chose when they had breakfast and supper. Lunch and dinner times were fixed but there were also snacks outside of these times. We spoke with the cook regarding the menus and she confirmed these had been devised with resident involvement. The cook said the catering budget was ample and that birthdays and other celebrations were catered for. We looked at the menu and could see that its was varied and their was always a vegetarian option at each meal. We looked at the record for food provided and saw that many residents chose alternatives which were provided. Lunch is taken in either the dining room or at a individual chair table in the lounge.Residents are able to have breakfast in bed or in the dining room, tea time tends to be a tray service but residents did say they can take supper and tea where they chose. Spiritual needs are identified and a holy communion service is held at the home monthly. Staff we spoke with said they understand the need to treat residents as individuals and they gave examples of this during our discussions. Care Homes for Older People Page 14 of 25 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 are protect by the homes safeguarding adult polices. They feel confident to raise any issues and it is evidenced that the service take concerns seriously and will investigate them and take action where necessary. Evidence: There is a complaints policy on display and also contained within the homes brochure. We received one concern regarding the dining room needing some repairs. We have reported upon this in the next section of the report. A complaints file is in place and this is reviewed each month by the responsible individual.The manager said that all comments and concerns are taken seriously and will always be investigated. Residents and staff we spoke with said they were confident any issues they raised would be investigated by the manager promptly. Residents said they had no concerns and dont worry about anything. We saw in staff records, and all staff we spoke with confirmed that they had received training in safe guarding adults. Two staff we spoke with told us what they would do if they though an abusive situation might have occurred. Since the last inspection one incident had occurred involving a resident with a person outside of the home however the manager made a safeguarding adult referral , to keep the resident safe from potential risk. Since the last inspection the safeguarding adults policy had been reviewed. We looked at this during our visit and identified a couple of amendments Care Homes for Older People Page 15 of 25 Evidence: were needed. These were rectified during the visit.The manager confirmed she would be speaking to all staff to inform them of the amendment, so their practice was current and in line with the services policy. Care Homes for Older People Page 16 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in clean and tidy surroundings which would benefit from a redecorating programme. Risk assessments keep residents safe from potential environmental hazards. Infection control measures from staff are good and review of the laundry flooring would improve infection control measures. Evidence: We toured the ground floor of the building and part of the first floor. Since the last inspection a concern was raised regarding the dining room having a leaking ceiling and sticking tape placed over the light switch and there not always being hot water available for resident bedroom sinks.The manager confirmed that the roof had been repaired and there were no more leaks. The lights had been disabled and other lighting was now provided. We saw paint which the manager confirmed was going to be used for repainting the dining room ceiling. The hot water taps were checked in a couple of bedrooms on the first floor of the service where the water had allegedly not been warm. The manager confirmed that a new boiler had been fitted and the water was warm when we checked it. The building is leased from a different company and it was not clear who is responsible for major decorating and repairs for the building. The manager said a maintenance plan had been produced but they did not have a copy of this at the time of the visit. Care Homes for Older People Page 17 of 25 Evidence: As we toured the building we saw that some wallpaper and paintwork was worn and in need of replacing. The manager accepted this and confirmed they were in discussion with the responsible individual to improve the decor of the service. Residents told us they thought some areas of the home were better decorated than others. Relatives we spoke to said it is a bit scruffy but the care is brilliant. Another relative said it could do with a lick of paint but i dont know if thats going to happen. We found furniture in the lounges and dinning room were in good repair and residents had a toilet located close to the communal areas for ease of access. Staff told us they had received training in infection control and we saw staff wearing gloves and aprons when undertaking care tasks. The kitchen and laundry are behind a secure door so residents have limited access. The laundry was functional but the flooring was becoming worn in places which is a potential infection risk. The manager said this had already been identified and action was being taken. There is a resident kitchenette which is available for residents to use to make drinks and light snacks. We spoke to the manager regarding keeping the kitchen door locked if staff were not around as one resident were seen to journey around the home and would not be aware that the water in the drinks maker was hot. Since the last inspection work has been carried out to produce risk assessments for hot water taps at hand basins. We saw these in care files and they had been signed by the manager.The manager said the risk assessments were reviewed every month to ensure residents remained safe. We did not check this on this visit.We found the home to be clean and fresh and tidy. Residents said they were satisfied with the cleanliness of their rooms. Care Homes for Older People Page 18 of 25 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. Residents are supported by sufficient numbers of staff. Recruitment procedures are satisfactory but would benefit from being more robust in respect of information gathering. Ongoing training enables staff to learn more skills which will improve the quality of the care provided. Evidence: We looked at the recruitment records for three of the staff . Two of these staff had been recruited since the last inspection. We saw that all the necessary paperwork was in place including references and criminal record bureau checks and identification. References for two of the files had the most recent employer recorded as the main referee but this was then changed to a different referee. The other reference was for the previous place of work but the name given was not the manager or owner of the care service.We also saw that the details in the application form requesting details of the start and leaving dates and reason for leaving the last place of employment were not completed. The means that the manager does not have as much detail as is possible to make an informed decision to employ the carer. We were told by residents that they felt there are sufficient staff on each shift. We saw that there are always at least four staff on each shift and the manager was always on call. The staff we spoke with said they thought there was very good team morale and shifts would normally run smoothly .There is very little agency cover as staff will normally cover shifts if a carer Care Homes for Older People Page 19 of 25 Evidence: calls in sick. This means that residents benefit from the people who know their needs, caring for them. We looked at training records and saw that staff received an induction programme and were also required to attend ongoing training sessions which were relevant to the support they provided.These included moving and handling, infection control, basic food hygiene and first aid. We saw training records which showed the last training provided had been a few weeks previously and this had been sensory deprivation training.Ten of the eighteen staff employed had obtained the NVQ (National Vocational Qualification) in Health and Social care. This means that they may have more skills and knowledge and be able to provide an improved quality of support. Residents we spoke with made positive comments about staff such as they are very good and know what they are doing and they are caring and do a good job. The manager said that all staff worked a trial period and if there were any issues the care worker would not continue to be employed. The manager said she was supported by the responsible individual to take any disciplinary action she felt was necessary. We observed a lot of interactions between staff and residents and saw that staff had very good relationships with all of the residents.Staff understood that the service was the residents home and that they were there to provide support while still enabling the residents to be as independent as possible. Relatives we spoke to said I feel the staff here are very good even when they are new they learn how to look after the residents very quickly and I think the carers are very good . They always seem to understand what my mum is saying. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a service which is well managed by an experienced manager. Quality assurance systems need to be developed to ensure a robust system for moving the service forward is in place. Staff supervisions sessions and resident meetings enable the manager to be clear on those areas for development. Evidence: The home is operated on a day to day basis by the registered manager Mrs Jean Benjamin. Mrs Benjamin has been the registered manager at the service for many years.Residents and relatives we spoke with during our visit made only positive comments regarding the manager includingShes very good and she will always walk around making sure everything is right and I find her very easy to talk to and its clear she is very caring. Staff said they had a good relationship with the manager and one staff said i get on very well with her, she is very easy to go to with any questions or ideas. Care Homes for Older People Page 21 of 25 Evidence: Since the last inspection work has been carried out on the Quality assurance system and questionnaires are now given to residents and relatives rather than verbal checking of their views. We discussed with the manager about increasing the numbers of people who are given questionnaires and how this might start to include other stakeholders such as GPs ,Care managers, district nurses and other people involved with the service. This would mean that the views of people visiting the service could be considered along with those people who live in the service ,which may assist in moving the service forward and continuing to evolve. As part of the Quality assurance system regular auditing takes place throughout the home. Samples of this were seen and included a catering review February 09, pressure sore management March 09 ,laundry February 09, housekeeping January 09 and medication February 09. The AQAA records that all polices and procedures have been updated and this included all heath and safety issues. The manager stated that during the monthly visit from the responsible Individual all health and safety issues are discussed This includes how many accidents occurred and any notifications which have been sent to us, the Commission. Since the last visit staff now receive supervision every other month and this is recorded on the matrix system the manager has produced so that she is able to closely monitor all training staff receive. Staff and residents both confirmed that meetings take place every three months and minutes were available for these. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 23 of 25 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 19 23 The internal decoration of the service must be in a good state of repair. This includes decor of a satisfactory standard. Residents should be able to live in comfortable surroundings and the current decorative state of some areas does not promote this. 30/06/2009 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 Care Homes for Older People Page 24 of 25 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!