Inspection on 11/03/09 for Abbeymere Care Centre

This inspection was carried out on 11th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeymere Care Centre 21/02/08

Abbeymere Care Centre 21/08/07

Abbeymere Care Centre 20/03/07

Abbeymere Care Centre 04/01/06

Abbeymere Care Centre 22/09/05

Abbeymere Care Centre 24/03/05

Abbeymere Care Centre 18/05/04

Abbeymere Care Centre 08/07/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbeymere Care Centre 12 Eggington Road Stourbridge West Midlands DY8 4QJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jonathan Potts     Date: 1 1 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 32 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 32 Information about the care home Name of care home: Address: Abbeymere Care Centre 12 Eggington Road Stourbridge West Midlands DY8 4QJ 01384395195 F/P01384395195 abbeymere@abbeycare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Karelink Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 18 Number of places (if applicable): Under 65 Over 65 12 6 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 Abbeymere Care Centre is registered for the care of 12 older people and 6 people with physical disabilities over the age of 65. The Home aims to enable people from a multicultural society and diverse community to continue living as independently as possible by receiving care and support consistent with their incapacities and disabilities. Abbeymere is a converted and extended residential property and is located in Wollaston, within a short walking distance of the village, this having a variety of amenities and facilities. The house is on a main bus route giving access to neighbouring towns. Care Homes for Older People Page 4 of 32 Brief description of the care home The building comprises of a large communal lounge, dining room and a number of bedrooms (as well as kitchen, laundry, bathroom and toilets) on the ground floor and bedrooms, bathrooms and toilets on the first floor. The home has a shaft lift and some other aids and adaptations consistent with the needs of older people. There is some car parking space to the rear of the building. The staffing in the home consists of a acting manager who is supported by senior care and care staff as well as ancillary members of staff. A director of the company is responsible for line management support to the acting manager. Information regarding fee levels was drawn from the homes Statement of Purpose on the day of the visit. The fees range between 362 to 405 pounds per week. This does not include extra services such private chiropody and hairdressing. These are all available at extra cost to the residents. A statement of purpose and service user guide is available to inform residents of their entitlements including how to access a copy of the inspection report. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced visit to the service took place over one day and involved one inspector and an expert by experience. Evidence of the homes performance against a number of key standards was measured through focusing on the care received by three individuals living at the home. This involved us looking at care records, talking to the individuals, staff and the acting manager as well as observing the staff interaction with people at the home. Further to this we reviewed other management records, toured the premises and spoke to residents, relatives and staff. We also reviewed information received over the previous 12 months, this including such as the annual quality assurance assessment submitted by the home, notifications, comments from individuals living at the home, their representatives and and other Care Homes for Older People Page 6 of 32 professionals. What the care home does well: What has improved since the last inspection? What they could do better: The management need to be more conscious of how they manage safe guarding referrals so that these involve all statutory agencies in accordance with multi-agency procedures. We noted some improvement in the clarity of the individuals care plans that we saw, although there is scope to further improve in this area so that information for care staff is unquestionable clear. The use of individual risk assessment, where identifying such as choking risks for individuals needs to inform information within the care plan. Risk assessments could be better in some areas such as in respect to use of beds rails, hand sluicing and use of such as baby monitors (the latter a potential invasion of privacy). Where hazards may exist (such as loose toilet surrounds and hand sluicing) steps need to be taken to minimize or remove these risks. There is scope for some staff training in respect of use of hoists and specific health care needs where the provision of more knowledge would be helpful to staff (for example diabetes, epilepsy and schizophrenia). Care Homes for Older People Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 10 of 32 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. Individuals are given the information they need to make an informed choice about whether or not they want to live at Abbeymere, this supplemented by a offer to view the facilities and spend some time at the home. Evidence: We saw that the home has a statement of purpose that is specific to Abbeymere and sets out a range of information about the service provided. We saw that the statement of purpose and service users guide is readily accessible in the homes foyer and contains the full range of information expected, this including such as the aims and objectives of the service, procedural information, details of staffing arrangements, useful telephone numbers and such like. From looking at case files for recently admitted residents we saw evidence that a copy of this information is sent out to prospective users and their representatives. People we spoke to told us how they came to be living at Abbeymere and told us that they had the opportunity to visit the home Care Homes for Older People Page 11 of 32 Evidence: pre admission. People told us that the choice to move into Abbeymere had been a positive one, and that they had received sufficient information about the home prior to moving in. The owner told us in their annual quality assurance assessment that they are looking to keep the homes information for prospective and current users under review. We noted that the availability of a small brochure is useful in summarizing the key points from the statement of purpose and service users guide. We saw copies of terms and conditions in the individuals records that we looked at and three people told us through questionnaires that they had all received copies of these. We also saw that the information in respect of charges for living at the home are now much clearer, and available as an addendum to the other information in the homes foyer. We saw from looking at recent admissions to the home that the company director carries out a detailed assessment prior to admission, this in most cases supported by information from other professionals pre admission; this so as to allow for sufficient information in deciding as to the suitability of the placement in meeting an individuals needs. In the one instance where the home has not obtained a social workers assessment prior to admission, we saw that this was obtained very shortly after and was consistent with the information in the homes own assessment. We saw that assessments are wherever possible completed with individuals or their representatives, and information within these reflects some of their wishes and preferences. Care Homes for Older People Page 12 of 32 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 health and personal care that people receive is appropriate to, and based on their individual needs. Staff promote the principals of respect, dignity and privacy in the way they provide personal care. Medication management is safe. Evidence: From looking at three care plans and associated records in some depth we saw that there has been some improvement in the way information is set out. Information we saw drawn from assessments is usually transposed into care plans. As the initial assessments involve the individual or their representative their views, wishes and preferences are carried through in part to the care plan, the latter seen to be agreed and signed by the former. On a positive note the care plans are not overly long and as a result the information within them can be read quickly. Based on the needs identified in assessments there are some areas where staff training maybe beneficial in respect of such as epilepsy, diabetes and schizophrenia. We did see areas where the assessments/care plans identify specific needs that are Care Homes for Older People Page 13 of 32 Evidence: not always fully followed through into actions staff should take examples including response to hyper/hypo glacemia (for diabetics), what staff must do to manage such as identified choking risks and epilepsy. Discussion with staff indicated that there was an awareness of how to approach these issues and in some cases there was general information available in the file that was not referenced in the plan (for example how to respond to hyper/hypo glaecemia). Discussion with the acting manager indicated that staff have to date not received formal training in care planning, and the provision of this would be beneficial in assisting them to complete and review care plans so that they are accurate, specific and encompass all the information within the homes (and other professionals) assessments. We saw that there are individual risk assessments in place that cover health related issues such as nutrition, risk of falls, tissue viability. We did see instances where these identified high risk (such as in respect of tissue viability), this not always translated into identified preventative actions within care plans. Comments we received from discussion with individuals and their representatives during the course of our visit did show that there was a high level of satisfaction with the personal care provided to them by staff. Examples of this we saw through the individual attention staff gave to residents such as taking care of their personal appearance (varnishing females nails for example) and sitting to talk to them when providing personal assistance. People we spoke to gave praise to the staff and we saw that interaction between individuals and staff was light hearted and appropraite. We saw that staff encouraged people to retain independence where possible, this confirming what people told us such as staff encourage you to get on your feet. We received three questionnaires back from service users that told us that they always receive the care and support they needed. Two stated in addition they also received the medical support needed, the third saying this was usually the case. From comments received from individuals during our visit, as we also saw confirmed by records, the staff are proactive in ensuring people have timely access to community health care services. They also facilitate access to private health care (such as chiropody) where this is requested. In accordance with the homes procedures and objectives we saw during our visit that staff respect individuals and we were told that privacy is promoted. People can spend time in their bedrooms as they wish and we were told that keys to rooms are offered to them. We saw that intimate personal care such as toileting was carried out in a quiet, gentle and unobtrusive manner. We saw staff knocking residents bedroom doors prior to entry on a number of occasions. The caring and respectful attitude of staff confirms the commitment made by the provider to the national Dignity Champions scheme. The only concern we identified in respect of an individuals privacy was in Care Homes for Older People Page 14 of 32 Evidence: regard to the use of a baby monitor, this used to establish when an individual was getting out of bed at night and at risk of falls. This response was said to be to promote their safety, but we saw no clear consultation as to the individuals agreement with this monitoring. We saw that the home has an appropriate medication procedure and that the systems in place for administration, storage and documentation of medication are accurate and safe. The most recent inspection of the homes systems for management of medication by the homes contracted pharmacist raised one issue which was the lack of medication reviews, this an issue that we saw the home has raised with the appropriate G.Ps. The home has upgraded its medication storage facilities to enabled them to comply with the requirements for storage of controlled drugs. Care Homes for Older People Page 15 of 32 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. People who live at Abbeymere are supported to make choices about their daily life and stimulation is available to them through appropriate activities. People have access to foods of their choice, and they are supported appropriately when eating. Evidence: We talked to people about their daily routines and how they could influence these and they told us that they have some flexibility as to what they do and when. We saw that the home has completed individual assessments related to preferences and activities of daily living so as to identify preferred daily routines. We spoke to individuals that were sat in their bedrooms and they told us that this was their preference and they could go into communal area when they wished to have company. We heard that community involvement has been promoted through such as links with a local church luncheon group where a number of individuals go for a meal, games and a service with the opportunity to meet their spiritiual needs. Staff also take residents out to the local shops on a planned basis. The home was seen to have an activity programme that was on clear display, and we saw from copies of residents meetings that consultation takes place as to satisfaction Care Homes for Older People Page 16 of 32 Evidence: with this or where changes could be made. There is also discussion in these meetings as to the homes menu. We heard about how the staff relate activities to national events (we saw on going preparations such as fancy dress for comic relief) and how birthdays are celebrated with parties. A number of individuals spoke of their interest in reading and to this end newspapers are delivered to the home, there are magazines available and the library visits every couple of months to provide books for residents to read. We saw from the activities programme that light exercise is incorporated within this using such as darts and ball games. At the time of our arrival at the home we saw that people in the lounge were involved in activity, some reading newspapers and others chatting and singing along to music. Some of the staff we saw involved in talking to residents. One individual is a keen gardener and discussion with them centered around their plans for growing tomato plants. They told us life at Abbeymere was better than at other homes and that staff did not ignore them, and also helped alot with their feelings. Discussion with individuals living at the home indicated that they are satisfied with the activities and stimulation available at the home, this including entertainment that is brought in. The home has an open visitors policy and visitors we spoke to said that they felt involved by the staff, with one relative assisting with the fancy dress for the comic relief celebrations. Where people want to see their visitors in private they are able to use their bedrooms. We saw that there are spare chairs available in some of the corridors for visitors to use as needed. We were told that visitors can eat with their relatives if they wish to and they are offered hospitality. We saw the homes has a menu that is available to individuals living at the home, this offering a choice of foods that are varied and nutritious. From sight of the meal we saw on the day this was consistent with the menu. We tried the meal of the day and found it was tasty and well seasoned and appropriate to the age of the individuals living at the home. We saw and heard staff offering people if they wanted condiments for their meals and saw that they were readily available to assist people as needed. We were told that the bread and butter provided to accompany the meal was offered after people requested this at a residents meeting. Staff asked people after the meal if they had enjoyed it and the sweet provided was again another choice made by residents that we had seen documented in meeting minutes. We also noted that food was not removed until individuals had finished with it, and staff were knowledgeable as to eating habits that were based on such as rationing during war years. We also noted that one resident who was not feeling well was encouraged to have a light meal, with this timed at a point that allowed the staff time to encourage them. Care Homes for Older People Page 17 of 32 Evidence: We also saw that staff encouraged residents to drink throughout the day, this with them spending time and not splitting their attention to other tasks until they were satisfied that the individual had a reasonable fluid intake. When asked people told us that they liked the food they had and confirmed that they had choice, this substantiating what we had seen and heard during the meal time. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals using the service are aware of how to complain and staff listen to concerns that they may have. The management have not followed multi agency procedures in responding to abuse in collaboration with the social services department, this possibly compromising any investigation by the responsible authority. Evidence: We saw that the home has a complaints procedure that is made available to individuals and their representatives at the point of admission as well as been on clear display within the home, this in larger print. There is also information freely available in respect of other agencies that people may wish to contact with concerns, this including advocacy agencies. Three questionnaires we received from individuals living at the home all stated that staff listened to them and acted upon what they said, and all three stated that they knew how to make a complaint. This was supported by our observation of the staff team interacting with individuals on the day of the visit to the home, where we saw that they had an open relationship with them, and felt no reluctance when expressing feelings of pleasure or dissatisfaction. We have seen that the home has had appropriate procedures available in respect of safeguarding and protection, and that staff have received guidance in respect of adult protection and safeguarding. Despite this there have been recent safeguarding referrals made by the home that have highlighted some concerns as to the providers Care Homes for Older People Page 19 of 32 Evidence: knowledge of local authority safeguarding procedures. In the first instance, whilst appropriate action was taken to report the issue to the local authority and ourselves, and steps were taken to protect the individual involved, the provider then took unilateral action in investigating and concluding the matter prior to a multi-agency strategy meeting. We discussed this matter with the individual involved, who stated that they were satisfied with the outcome however, and had no current concerns as to life at the home. The second issue was reported, although there was a noted delay before the local social services team was made aware. We did note that the acting manager told us that they had taken steps to protect the individual however. There is a need to ensure that the home works with the framework set out by the local authority and to allow this all staff must be aware of, and follow the multi agency safeguarding procedures. Comments we have received form social services indicate that the home did not have a copy of these procedures. We also noted that records relating to the recording of the second incident were of poor quality and show scope for improvement. Whilst we are aware of the staff having received adult protecting training since November 2008, the outcomes in terms of management of safeguarding issues that have arisen suggests there is a need for further training, preferably sourced from the local authority. The management of the home should be involved in this training. Care Homes for Older People Page 20 of 32 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. The home provides individuals an environment that is well furnished, homely and comfortable, the size of the home assisting some individuals with independence. There are some areas where infection control practices present risk. Evidence: We toured the premises on the day of our visit to the home. This includied a sample of the bedrooms and we saw clear evidence of on -going improvements, the most notable the redecoration of the dining area, which whilst not completed at the time was far lighter than previously, this helped by the fitting of a new skylight. The dining room chairs have also been replaced, the new ones more appropriate for the needs of the individuals living at the home. We saw that the communal areas and bedrooms were clean and fresh with no evidence of any malodours anywhere in the building. We saw that cleaning rotas have been introduced, these seen to be completed as tasks are carried out. Discussion with the acting manager indicated that they were clear as to the homes redecoration and refurbishment programme with plans to replace such as some of the older windows in the house, fire doors and subject to planning permission (which the provider was appealing) build a conservatory at the rear of the building. We also noted that new bedroom door plaques with individuals names have also been fitted on every bedroom door. We spoke to some individuals who told us that they are happy with their bedrooms, and another individual highlighted the fact that she chose Care Homes for Older People Page 21 of 32 Evidence: the home as its smaller size (compared to others she had visited) helped with her independence as it was easier to find their way around. We saw from documented certification that equipment within the home, and fixtures have been maintained appropriately. Where we noted frayed carpets at our last visit these have been attended to (through such as new carpets) and all the bed headboards are now fitted to beds. The last food safety inspection by Dudley MBC was in November 2008, the home awarded one star (Poor, improvements required). Hygiene and safety compliance was said to be of a high standard however. The acting manager stated that at the time of the inspection there was re plastering taking place in the kitchen which she felt had an impact on the homes score. This work was seen to have been completed at the time of our visit. We noted that the home has a number of adaptations in place including hoists, adapted bathrooms, showers and handrails. A number of the bedrooms (that have en suites) we saw had toilet surrounds in place, some of these found to be loose and one damaged. The damaged one we were told would be taken out of use on the day of our visit although the provider needs to ensure that all the ones in use are stable and secure, which was the case for some we saw. A number of individuals also have bed rails fitted, due to concerns related to their falling from bed. We saw that there are risk assessments in place for these, although we did advise the acting manager to make use of Health and Safety Executive information to assist in the development of more robust risk assessments and monitoring forms related to the safety of this equipment. As this includes a training pack this would also allow training for staff. The home has infection control procedures that have been adapted from those in use by Wolverhampton Primary Care Trust. These are robust but we noted that there are practices in the home that do not follow this procedure, the most notable concern hand sluicing of linen, this carried out in a sluice sink on the 1st floor of the home. The process of hand sluicing is not risk assessed. We also noted that the home currently has a domestic washing machine, where a commercial one with sluice cycle would be more appropriate. The home has a small laundry that despite been cleaner than at the time we last saw it still contained a number of extraneous items, and we noted the soap drawer of the washing machine to be clogged with old powder. People told us that the home is always or usually fresh and clean this supporting what we saw on the day. We also saw that protective wear for staff was readily available around the home, with paper towels and liquid soap in toilets. From sight of the homes training plan we are aware that the majority of the staff team have received infection Care Homes for Older People Page 22 of 32 Evidence: control training. Care Homes for Older People Page 23 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are enthusiastic, caring and work hard to provide individual care to people. The homes recruitment practices are safer and staff are generally well trained, with some areas where this could be improved, this to enhance knowledge in respect of some individuals needs. Evidence: We have noted that there has been an some increase in staffing levels since the time of the last inspection, this from information drawn from the annual quality assurance assessment submitted by the provider, the staff rotas we saw and sight of the staff at the home on the day of the visit. We saw that at peak periods there are up to four care staff with ancillary staff supporting these including a cleaner and cook, who are available in the mornings. Three questionnaires we received from service users told us that staff are always (2) or usually (1) available when needed this supporting comments we received on the day of our visit, such as staff are marvelous just call when needed and staff dont ignore me like they have done in other homes. We saw a number of occasions where staff were providing individual attention and people told us they felt well cared for. The improvement in the level of activities and stimulation provided to individuals is judged to be related to the improved staffing provision as well as the motivation of the staff in becoming more pro-active in this area of care. Care Homes for Older People Page 24 of 32 Evidence: From what we saw on the day of the visit we saw that staff take the time to care for individuals and provide them with the time and attention that they need. Care staff do the laundry and cleaning on the week end and it was suggested to the acting manager that support staff to cover these periods could be beneficial in releasing the care staff to carry out more direct care. We checked the homes recruitment procedures through looking at 3 files for staff that recently joined the homes workforce. Overall these contained evidence that all necessary checks are carried out prior to recruitment with the exception of some staff employed prior to receipt of an enhanced disclosure, although this was risk assessed and followed receipt of a POVA check. The manager stated that these staff were supervised by senior staff until their disclosure was received (as detailed in the risk assessments seen). We did note that there were no photos in staff files however as should be the case. We did see evidence of documented one to one supervision with these staff. We saw no documented interview records which would be useful in evidencing the homes selection procedure. We saw clear evidence of the staff participating in an induction that followed national standards. We looked at the homes training plan, which the manager stated did need updating. This did show us that staff are trained in most core mandatory areas including such as first aid, food hygiene and moving and handling. The acting manager was not able to verify that staff have received training in use of hoists however, although said she would check this with the training provider. Well in excess of 50 of the staff have received vocational training (either NVQ 2 or 3 in care). There was evidence of staff having training in sensory deprivation and dementia (this applicable as some individuals at the home have needs in these areas); but the provision of training/guidance in such as epilepsy, diabetes and schizophrenia would be useful as this relates to specific needs within the resident group. One staff member has completed a therapeutic activities course since the time of the last inspection. The training detailed above was evidenced by sight of certificates as well as the training plan. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is now more consistency in the management of the home this reflecting improved outcomes for individuals living at Abbeymere, although there is still scope for increasing the confidence of other agencies in the homes management. Evidence: The home is run on a day to day basis by an acting manager with support provided by the provider. We have been informed that it is the intention of the provider to put the acting manager forward for registration. Since the time of the last inspection (this around the point the acting manager was appointed) we have noted a clear change in the homes atmosphere with staff now much friendlier and also showing far more commitment to the care of the people living at the home. Whilst there is scope to develop the acting managers management skills (this to be assisted by management training). From discussion with the acting manager and the improving outcomes we have seen from this inspection Abbeymere is clearly a better home for her input. Staff present as more relaxed and individuals living at the home seem comfortable in raising Care Homes for Older People Page 26 of 32 Evidence: their views. We noted that one to one supervision from those staff files we saw has improved, this indicative of the improvements seen in staff attitudes. There is a need to ensure that the home addresss issues related to the referral of safeguarding alerts and joint working with other agencies. The providers intention to progress investigations without joint working suggests either a lack of knowledge as to multi agency procedures or a desire to work unilaterally. This will not engender confidence in the management by commissioners who have a responsibility and duty of care towards the individuals they place at Abbeymere. In addition, in instances where there is possible criminal offences the investigation by any agency other than the police may corrupt potential evidence. We saw that the home consults with individuals living at the home, relatives and professionals the results summarized and available within the home in the service users guide. This shows that the people that use the service have a high level of satisfaction with the service (overall view was that 57.5 thought the service was very good and 36.5 thought the service good). In addition we saw that there are meetings with residents where they can share their views on the running of the home in respect of such as menus and activities. The director for the company submitted an annual quality assurance assessment to us prior to our visit to the home and this was generally well completed. The acting manager told us about a new quality monitoring system that the home is to use, this commenced on the 12.1.09. We checked the records for monies and valuables in safe keeping, this for the three individuals whose care we tracked. We found records related to these monies to be accurate and well recorded. We did however note that inventories of property that the individual may have in the home are not documented, this meaning if items are mislaid it would be difficult for the home to evidence what was present. Such inventories may relate to clothing but should also note any items of greater value such as jewelery that people wear, items of furniture they bring into the home and such like (as we saw had been the case for some). We saw that the home has a health and safety policy and related procedures in place. Overall we saw that records related to safe working practices that we sampled are satisfactory, and use of such as accident analysis has been seen to inform the homes fitting of such as handrails in areas needed. We saw that there has been some risk assessments identifying potential hazards within the home although there is scope for expansion of these, with the obvious exceptions we noted in respect of hand sluicing and the need to improve risk assessments relating to use of bed rails. We discussed with the acting manager the possible use of an audit of the environment to identify all potential hazards, which could then lead to comprehensive assessment of the same. Care Homes for Older People Page 27 of 32 Evidence: The homes policy in respect of smoking has been revised, this now a blanket no smoking policy, this protecting individuals from second hand smoke. We noted that following the last Environmental Services inspection (relating to food hygiene) there was an expression of poor confidence in the management of the home. Care Homes for Older People Page 28 of 32 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 29 of 32 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 18 13 The registered person must ensure that they, and all staff at the home are aware of the appropriate measures for the reporting of abuse to statutory agencies. This is to ensure that no service users safety is compromised by the actions of the staff or management. 31/05/2009 2 22 13 The registered provider must ensure that toilet surrounds in use are stable and safe to use. This is to ensure that falls do not occur from use of such equipment. 31/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 To ensure that issues identified within assessments/care plans are followed through into clear actions for staff within Page 30 of 32 Care Homes for Older People care plans/risk assessments. For example where there is an identified risk of choking it is clear as to what staff must do to prevent this occurring wherever possible. 2 7 To ensure the level of risk identified within tissue viability assessments is reflected as preventative actions within the individual care plan. To gain clear permission from individuals when using baby monitors to oversee their movements at night. The registered provider should ensure that any reports relating to incidents where an individual is at risk of harm are fully documented. The registered provider should access training from the local social services department in respect of the multi agency safeguarding procedures. To ensure that more robust risk assessments in respect of bed rails are introduced and staff are provided with training in this area through use of Health and Safety Executive guidance (www.hse.gov.uk/healthservices/bedrails/) To look at ways in which the the use of hand sluicing can be superseded by safer methods of sluicing linen and such like. To consider the purchase of a commercial washing machine. The provider should put forward a suitable applicant for registration as manager of the home There should be documented inventories of any valuables that individuals bring into the home with them at the point of admission or there after. 3 4 10 18 5 18 6 22 7 26 8 9 10 26 31 35 Care Homes for Older People Page 31 of 32 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. 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