Inspection on 20/03/07 for Abbeymere Care Centre

This inspection was carried out on 20th March 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

Abbeymere Care Centre 11/03/09

Abbeymere Care Centre 21/02/08

Abbeymere Care Centre 21/08/07

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Abbeymere Care Centre 12 Eggington Road Stourbridge West Midlands DY8 2QJ Lead Inspector Mr Jon Potts Key Unannounced Inspection 09:40 20th March, 20 & 26th April 2007 th 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 Abbeymere Care Centre DS0000024951.V325333.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. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeymere Care Centre Address 12 Eggington Road Stourbridge West Midlands DY8 2QJ 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 395195 F/P01384 395195 Karelink Limited Mrs Judith Christine Boden Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability over 65 years of age (6) of places Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8/3/06 Brief Description of the Service: 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, which has a large variety of amenities and facilities. The house is on a main bus route giving access to neighbouring towns. 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 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 manager who is supported by a deputy and care staff as well as some ancillary staff. A director of the company is responsible for line management support to the manager. The charges range between £343 to £385 per week dependent on whether the room has an en-suite facility. This fee does not cover toiletries, tissues, private newspapers, hairdressing, private chiropody or dry cleaning. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over three days, the third day of the inspection carried out by a pharmacy inspector, this to assess the homes compliance with the standards and law in respect of the safe administration of medication. The inspection overall focused primarily on the homes performance against key national minimum standards and evidence was drawn from a variety of sources including case tracking the care for five residents, this involving the inspector examining individuals care records, talking to the resident where possible, and the staff that provide care to them. Time was also spent looking at a range of management records, touring the premises and discussing issues with the registered manager and provider, the latter only on the 1st day of the inspection. The home provided some information pre inspection and there was also some comment from residents via CSCI questionnaires. The residents, management and staff are to be thanked for their assistance with the inspection process. What the service does well: The two aspects of the service that were highlighted as good by residents was the meal provision that included residents been offered ample choice and in the opinion of most enjoyable meals. Some married couples were also clear that the home allowing them to use two bedrooms as a lounge/bedroom was instrumental in allowing them a better quality of life. Staff also presented as knowledgeable in some areas of practice that was indicative of the home having a high proportion of staff with a vocational qualification in basic care skills. This does provide a base for the registered person to build upon with more specialist training. The majority of residents spoken to also expressed confidence in the manager, or provider’s willingness to resolved issues and some said they had direct experience of this. More able residents stated that routines in the home were flexible and they had access to sufficient stimulation through the day. The positioning of the home is also lends itself to easy access by car or bus and is ideally sited for easy access to a range of shops in the centre of Wollaston. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Despite some areas showing promise there were many others areas where the home needs to improve, a number that relate directly to the safety of the residents these as follows: • Medication systems do not always follow good practice or safe practice guidelines and action is required to improved this. • The skills of the staff group to provide care for some residents is lacking and training needs to target these gaps so as to equip staff to provide more specialist care. • Care plans are not robust enough in presenting a clear direction for staff to meet all of the individual residents health, social and emotional needs. In addition risk assessments related to the individual needs of residents and how this may endanger them are not always in place, and in cases where they are, they are not followed by staff. • More generalised risk assessments in respect of the environment were not available (except for fire safety) and need to be devised. • The registered provider needs to consider staffing levels against the difficulties presented by the staff intensive needs of some more dependent residents and in response to areas where other residents have asked for assistance with external social activity. • Recruitment checks need to include an enhanced disclosure as opposed to a standard one so as to provide a higher level of protection for residents. • Hoists must be serviced more frequently to ensure they are safe to use. Please contact the provider for advice of actions taken in response to this Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 7 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. Abbeymere Care Centre DS0000024951.V325333.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 Abbeymere Care Centre DS0000024951.V325333.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): 1,2,3 & 4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective people looking to use a service, and their representatives have information needed to choose a home, which they said was sufficient to allow them to make a decision as to their admission, and in most cases whether the home could meet their needs. They have their needs assessed and a contract which clearly tells them about the service the will receive. EVIDENCE: The service has developed a Statement of Purpose, which sets out the aims and objectives of the home, and there is also a service user guide, which provides basic information about the service and the care the home offers. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 10 When the provider writes to prospective residents or their representatives confirming the offer of a placement the letter points out that the statement of purpose and service user guide are available at the home to read, but they are not automatically provided with a copy. A copy of the homes brochure was stated to be provided however, this with the homes complaints procedure. The information is available in a standard written format, and not in large print and the views of the current residents are not included within the documents. Admissions are not made to the home until a full needs assessment has been undertaken, this by the provider who then discusses the admission with the manager of the home. Where the resident is funded through care management arrangements the service insists on receiving a summary of the assessment, although care plans from social workers were not always available. The assessment involves the individual, and their family or representative, where appropriate and comment from some residents spoken to and CSCI questionnaires indicated that they had enough information prior to moving into the home. The provider and manager consult the assessment information to see if they can meet the prospective individual’s needs before they make the decision to accept the application for admission and offer a placement. Assessments are carried out before prospective residents are admitted to the home. There was some concern however that a recent admission to the home was for a resident whose primary need was clearly outside of the homes categories of registration and had needs that staff were unable to easily meet based on comments from some staff spoken to during the inspection. Staff do not currently have training in working with mental illness or positive management of potentially challenging behaviour, this meaning that some of the staff spoken to were concern as to their ability to manage the needs of one resident who on one hand was labelled as ‘aggressive’ by staff and by management as ‘attention seeking’. The information in initial assessments does indicate that the resident is attention seeking and the lack of staff skill in management of this behaviour may be the reasoning behind their perceiving the resident as ‘aggressive’. Individuals are provided with a statement of terms and conditions/contract before or at the point of admission to the home. It gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy. Residents confirmed that they were aware of having received a contract from the home. Abbeymere Care Centre DS0000024951.V325333.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 poor This judgement has been made using available evidence including a visit to this service. Medication systems within the home are poor and do not always follow good or safe practice guidelines. The majority of residents are however satisfied with the provisions made for their health and personal care, and say that the principles of respect, dignity and privacy are put into practice; although their individual needs are not always set out in individual plans of care. EVIDENCE: Care plans that are in place in cases are poorly developed and do not always reflect the person although there was some limited improvement between the dates of the visits. Plans are based on identifying basic physical needs although there were omissions in cases where assessments, or residents, identified issues that were not explored in the plan, examples of this including diabetes, behavioural issues, visual deficits etc. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 12 Reviews of the plans take place sporadically and do not build on the information that is contained in the homes assessments such as activity profiles and nutritional assessments. Whilst some plans did carry some reference to communication needs these did not fully reflect the difficulties encountered in some instances where communication can be more difficult due to such as dementia. There was limited evidence of the residents or their representatives having signed care plans to evidence their involvement and understanding. Discussion with a number of residents did however indicate that some of the information in the care plans was accurate. The home was seen to have a key worker system in place with staff having responsibility for updating such as care plans for their designated residents, although there was no evidence of the staff having appropriate support through such as training in respect of care planning. There was evidence of some individual risk assessments although these were limited and in cases there was evidence that staff did not follow them. One moving and handling risk assessment stated that a resident was to be transferred only through use of a hoist, this to promote the individual’s and staff safety. In discussion with the manager and some staff it was stated that staff manually handled the resident due to concerns as to their agitation when using the hoist, this not reflected in the risk assessment. The manager was advised to seek a reassessment of moving this resident through the funding body without delay and following this to update and review the risk assessment so as to minimise any potential risks. Residents spoken to stated that they did have access to health care services both within the home and in the local community. The majority of people were satisfied with the provision of these services, which included local dentists, opticians, and other community services. In some instances health needs are monitored and appropriate action and intervention taken. The home is generally able to provide the aids and equipment recommended and residents are able to retain their own General Practitioner (GP) where possible in order to ensure continuity of healthcare. Medication procedures, storage and records were seen. The manager and deputy manager were spoken with. The home has good support from a local pharmacy that supplies the home with medication and also provides advice on medication. The pharmacist who supports the home was spoken with and said the staff were ‘kind and caring’. Medication Storage Medication seen was secure and locked within a dedicated medication cupboard in the dining area. The keys were held by the person in charge to ensure safety. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 13 Medication requiring cold storage was seen stored in an open plastic container next to food in the kitchen refrigerator. Controlled drugs, which require special storage arrangements, were not stored correctly within a controlled drug cupboard. Creams and ointments were stored together with tablets and liquid medication, which does not follow safe storage of medication. The pharmacist stated ‘I have told them about correct storage on numerous occasions’. Medication was provided in individual monitored dosage cassettes for each service user and also in original boxes or bottles, which were supplied from the pharmacy. Some medication stored in the cupboard was out of date or no longer required and had not been returned to the pharmacy for disposal. None of the service users looked after their own medication. There was no documentation available to show if they had been assessed on admission for their ability to self-administer their own medication. All staff who administer medication had completed an accredited ‘Safe Handling of Medication’ training course. A certificate was available which showed that the manager had completed a medication training course in 2005. Two members of staff were currently undertaking medication training. Medication Procedures There was no specific medicine policy available containing procedures for obtaining medication, receipt, administration, records, storage, controlled drugs, disposal, self administration or medication errors. This means that service users medication and healthcare needs were not being safeguarded with written procedures. The only procedure seen was a brief medication procedure for the administration of medication to service users. Medication Records Records for the receipt of medication were available, however the date of receipt was not documented. Records for returned medication to the pharmacy were available. There was no Controlled Drug Register available to ensure accuracy of records for this group of medicines. The pharmacist said ‘I have told them to obtain a controlled drug register on numerous occasions’. The date of opening on all medication boxes and bottles was not recorded and balances of medicines were not always available. This means that the service could not check service users medication and also a medication audit could not be fully undertaken to ensure safe administration to the service user. The administration of medication to service users was not witnessed, however the manager stated that medication would be administered to individual service users one at a time and the medicine record chart signed after the administration. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 14 All of the medicine record charts were seen, which were mainly pre-printed from the pharmacy. Service users allergies were not recorded onto the medicine record charts or ‘none known’ recorded where appropriate. Some medicine record charts had been hand written, however they were not signed and checked for accuracy by two members of the care staff team. The majority of the medicine charts seen were documented accurately with a signature for administration, however there were some omissions on the medicine records with no signature for administration or suitable code with reason why the medication had not been administered. One resident was prescribed medication to help with behaviour management such as agitation or distress. The medication was only to be given to the service user when necessary. There was no documentation available, which detailed under what circumstances the medication should be given to the service user. This means that the health and welfare of the service users were not adequately safeguarded. The pharmacy inspector saw three resident’s care plans. There was a small amount of information regarding resident’s medication. There was no consent to medication available and no information to show if an assessment had been made regarding the resident’s ability to self-administer their own medication. A record of healthcare professional visits was available which documented the reason for the visit and any medication changes were recorded. The majority of residents stated that staff treated them with respect and felt that they considered their dignity when delivering personal care. This was borne out in discussion with staff who were clearly able to cite examples of how they could promote a resident’s dignity and respect their privacy although there some concerns that one resident stated that staff referred to her as ‘naughty’ and written records carried reference to the same resident being ‘nasty’ with staff on a few occasions. Abbeymere Care Centre DS0000024951.V325333.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 good This judgement has been made using available evidence including a visit to this service. Residents expressed satisfaction with a lifestyle that generally met their expectations, and more able residents were clearly able to have a degree of control over their lives. Residents are able to readily maintain contact with family and friends. The home provides choice of meals that comprise a wholesome, appealing and balanced diet. EVIDENCE: Residents are consulted or listened to regarding the choice of activity through use of an activity profile, but this process could be improved by building the outcomes of this into the resident’s individual care plans. Residents spoken to stated that in their experience they had access to sufficient day-to-day stimulation and activity to satisfy them, and some spoke of the activities that were available within the home. A number did however state that they were not always interested and would pursue their individual interests. In this respect it was stated that routines within the home were flexible and residents stated that could please themselves as to what they did, Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 16 and when, and there was no restriction on their going to their bedrooms whenever they wished. There was evidence that staff use resources within the community such as the local church to provide residents with opportunities outside the home (as was observed during one of the days the inspector was at the home), and entertainment is brought into the home in the form of such as singers and representatives from a church. Residents have however raised that they would like to go out to the shops in meetings, this, the manager stating not possible as staffing numbers would not allow for this. The manager stated that as a compromise residents have the opportunity to walk around the homes garden. Policies, procedures and guidance promote individual independence and the right to live in a flexible environment where their choice of routines and activities are met when possible. Some married couples were seen to be living the majority of the time, at their choice, within their rooms, this an arrangement that was stated to be ideal for those residents concerned. The use of two bedrooms that a married couple can use as a bedroom and separate lounge has proved to be a positive opportunity for them to live in their own space with the reassurance of having access to assistance when needed. The residents also stated that they were able to eat their meals in their rooms if they wished. The home is to be commended in supporting these residents to maintain this degree of independence as well as intimacy. Residents told the inspector that their relatives were able to visit the home at any time without restriction and they were able to see them in privacy in their bedrooms, or go out with them if wished. Whilst residents that were able to clearly communicate their wishes expressed satisfaction with their ability to make choices at the home, the scope for others whose ability to communicate was impaired was not so obvious as there was a lack of direction in care plans in respect of communication with less physically or mentally able residents. The residents stated that they enjoyed the meals they ate at the home and were given a clear choice of meals by the staff. The meals are balanced (based on sight of the menus and the meals that were served) and nutritional and cater for the cultural and dietary needs of the individuals using the service. From observation and discussion with the staff and cook they are sensitive to the needs of those residents who find it difficult to eat and give appropriate assistance with feeding. Discussion with the cook as to the dietary needs and preferences of the residents from information presented in the case files or as told verbally to the inspector showed that she was readily aware of these, and in cases elaborated on information that was not readily available in care plans. In discussion it was however apparent that there was no written guidance available to her in respect of the dietary needs of diabetics. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents who can easily communicate are able to express their concerns, and have access to the complaints procedure. The majority of these residents are satisfied that they are protected from abuse, and have their rights protected. Staff do not always adhere to the homes risk assessments and policies in some cases, and have a poor understanding of behaviour management, which could compromise resident’s safety. EVIDENCE: The service has a complaints procedure that meets the National Minimum Standards and Regulations. The procedure is up to date and made available to residents and relatives but is not available in any alternative formats. The manager stated that the procedure is reinforced with residents at meetings with them bi – annually. Most individuals say they know how to make a complaint, and also state that any issues raised with the manager or provider have been resolved to their satisfaction. Based on the homes complaints log the home has received no formal complaints since the time of the last inspection in March 2006. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 18 Policies and procedures for safeguarding people who use the service are in place and clearly refer the reader to the local social services department’s policy and the government document no secrets. There was reference in homes policy to staff carrying out a preliminary investigation, which is potentially misleading and does not fit in with manager’s expectation that this would only be to establish if it was abuse, at which point it would be referred to social services. The policy was however clear that staff must speak to the manager if there were any potential issues and the action taken would be her responsibility. Staff spoken to have had training around Safeguarding Adults and expressed a reasonable understanding of the action to take in the event they were confronted with any instances of abuse. Staff working at the service had contradictory views of how to deal with potential challenging or disruptive behaviour, and were concerned as to the behaviour of one resident that was stated to have physically attacked staff. It was clear that staff have not had any training in management of such issues and lacked understanding as to why they may present. The view of senior staff and the assessment of the resident indicated they were ‘attention seeking’ and that the most positive way to deal with this was to consider appropriate occupation. This was supported by the presence of a detailed therapy sheet completed by an Occupational Therapist prior to this resident’s admission, this containing clear information as to occupation and interaction with this individual. If this is the case it was clear that some staff had difficulty providing this, which has the potential to present contradictory practices. In addition it was noted that whilst the home had a no jewellery policy, one member of staff was seen to be wearing a number of rings and one documented incident stated that a member of staff had a neck chain broken by a resident. The wearing of such items has the potential to damage a resident when carrying out personal care and the manager must be more proactive in enforcing this policy. As previously mentioned the manual handling of one resident in contradiction to the documented risk assessment seen that states a hoist should be used, presents what can be judged to be preventable risk. Any injury to the resident as a result of this could potentially be seen as abusive practice. A number of residents did however stated that they were usually satisfied with the care in the home and felt safe. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 19 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, 22,23,25 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in an environment that they feel meets their expectations and overall is well maintained. Identification of and assessment of potential environmental hazards could be better so as to ensure resident’s safety. EVIDENCE: The home provides a physical environment that is in the view of the residents spoken to appropriate to their needs and it was clear that the provider has taken steps to improve the environment decoratively since the last inspection with a number of bedrooms, the lounge and hall, stairs and landing redecorated. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 20 It was also noted that the environment presented as cleaner and fresher than previously seen with no odours detected at any time of the inspection. Specific areas where work was required at the time of the last inspection were seen to have been addressed. Aids and equipment consistent with the needs of an older resident group were seen to be available this included fixed bathing and mobile hoists. It was however noted that the mobile hoist, based on servicing information, had not been serviced as needed, with the manager unable to present evidence of servicing since it was purchased in April 2006. The provider needs to ensure that this hoist is serviced to ensure its safety for use. All other equipment was seen to have been serviced in accordance with expected time scales. People who use services are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of the individuals and there was evidence that the layout of the room could be changed according to resident’s preferences, or if their needs change. As previously mentioned the use of two single bedrooms together as a lounge and bedroom for married couples, was stated by the occupants to be ideal for their purposes. Residents were asked as to the availability of keys to their rooms and none felt this was necessary, although some stated that they would be able to have one if they requested. Residents stated that there is plenty of hot water although there was comment that the residents are unable to change the temperature in their rooms, although could request that this is done by staff. Where there were issues with a resident still finding their bedroom hot, they had been provided with a fan, which was found to be an acceptable solution. It was noted that whilst the majority of radiators in the home are now covered there are still a number that remain exposed, and the provider must be aware of the need to risk assess the potential hazards this presents in addition to any other risks the environment may present. At the time of the last Environmental Health inspection in 2005 this regulator highlighted the need for such risk assessments and if there is difficultly complying with this the registered provider is advised to discuss this matter with this agency. There have been no recent outbreaks of infection at the home and the staff spoken to were aware of the steps to take to prevent cross infection and equipment such as personal protective wear was seen and said to be readily available for use. Discussion with staff and observation evidenced that dirty laundry was handled appropriately. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 21 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 This judgement has been made using available evidence including a visit to this service. Staff in the home, which have the skills to support low dependency residents are in need further training to equip them with the skills to support the more dependent people who use the service. Senior staff also need clearer guidance as to their exact responsibilities when in charge, this to support the smooth running of the service. EVIDENCE: Most residents stated that they are generally satisfied that the care they receive meets their needs, but there are times when they said staff were busy, although there was reference to the response times to requests for help having improved recently. Whilst the home has sufficient hours to comply with the expectations of the national guidance tools there was comment from staff as to the difficulties encountered at times due to the fluctuating levels of demand place on them by high dependency residents. Comments from residents in meetings made reference to trips out of the home highlighting that the availability of only two dedicated care staff on most shifts (with a domestic and cook in addition) prevents the home from providing walks out from the home with the staff. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 22 There are also issues in respect of the competence of the staff in some instances, with it clear that there should be additional training input related to some areas of current resident’s needs related to mental illness and dementia. Additional guidance in terms of care planning and equality and diversity would also be beneficial. The manager acknowledged the importance of training and stated that the home tries to deliver a programme that meets any statutory requirements and the National Minimum Standards. The manager is aware that there are some gaps in the training programme and plans to deal with this, although did state that the provision of funding creates some difficulties, as this is only available to staff on a one distance-learning course at a time basis. The service is to be commended however for having supported the majority of staff in achieving a vocational qualification in care above the minimum required by national minimum standards, this giving them the basic skills required for caring for older people without complex needs. It was noted that when requested there was no job description available for the position of senior care and discussion with the manager indicated that when she or the deputy were not available staff where deployed as seniors on an ad hoc basis, and did not undertake this role on a more permanent one. Whilst the manager stated that staff undertaking this role were the more experienced staff there was no recognition of the fact that they were having to take on additional responsibilities over that of their substantive role. Staff acting as Seniors must be clear as to what responsibilities they are accepting, and there needs to be clear criteria as to which staff are competent to fulfil this criteria. The service has a recruitment procedure that meets the regulations and the National Minimum Standards with the exception that the provider obtains standard disclosures as opposed to Enhanced, which are those legally required for any staff working with service users. In addition any new staff employed must have a disclosure that has been obtained by the home, a copy of a recent disclosure from the last employer is not acceptable. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management needs to be more proactive in identifying areas where the home needs to develop. Recently introduced quality assurance systems still need time to develop and assist with effective management. EVIDENCE: The manager has a number of years of experience at senior level within the home and is qualified in NVQ level 4 in care but has not completed the necessary management components to achieve her Registered Managers award. Outcomes from the inspection suggest that the management style is reactive to situations and issues as they arise rather than proactive, with issues identified and dealt within prior to them becoming potential problems. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 24 As well as there been issues in respect of the senior staff having no job descriptions, it was stated by the manager that she has not been provided with one either, this a concern as there are no clear documented divisions as to exactly what the managers responsibilities are. The home has a Statement of Purpose that sets out the aims and objectives of the service although there would be some doubt as the service achieving all of these. In some cases it could be considered misleading as it states the manager has her Registered manager’s award when she told the inspector this is not the case. There is also concern as previously stated where policies in respect of such as staff wearing jewellery are not enforced, and risk assessments in respect of moving residents safely are disregarded with the knowledge of the manager. The provider has introduced a quality monitoring system although sight of this did evidence that there is more work to do to ensure this is fully operational and assists management develop a more proactive management style. The home was seen to have consulted with the resident’s relatives via questionnaires and there are forums set up for consultation with residents and staff (although staff meetings are only held annually). The homes does safe keep small amounts of residents monies and polices in respect of handling these were seen to be followed, with appropriate recording and storage of monies. Clear records of resident’s property at the home were also now seen to be kept. The manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation, although there are issues that require work, most notably the need to risk assess the impact of the environment in terms of resident and staff safety as was identified by Environmental Health. In the homes favour the staff spoken to, with some exceptions had a good understanding of their responsibilities in terms of health and safety and the majority had received training in areas related to safe working practices. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 25 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 2 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 3 X 2 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X x 2 Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 26 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 OP4 Regulation 12(1) a 18(1) i Requirement The registered person must ensure that staff have the appropriate skills and training to meet the needs of resident’s prior to and following their admission to the home. The review of resident’s needs that fall outside of the homes usual remit must be carried out to decide exactly what is required to allow their needs to be appropriately and fully met. To continue to develop the care plans so that they identify clear action to ensure that all aspects of the resident’s health, personal and social care needs are being met. These (plans) must be drawn up with the resident or their representative who must sign to acknowledge their agreement. This is a repeated requirement that was to have been met by the 31/03/07 Timescale for action 30/06/07 2. OP7 15(1) 30/06/07 Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 27 3. OP7 13(4) b & c The registered persons must ensure all significant areas of risk presented to residents must be assessed, this to identify and minimise the risks presented to residents. Furthermore staff must be aware of and follow all instructions set out in these assessments so that any management directives are not compromised. Areas of risk may include moving and handling, risk of choking, challenging behaviours and so on. The registered person must ensure that there is a medicine policy available, which is specific to the needs of the service and to ensure that the health and welfare of service users taking medication are safeguarded and trained staff follow safe practice. The registered manager must ensure that medicines for refrigeration are stored securely to ensure the safety of service users medication. Controlled drugs stored in the home must meet The Misuse of Drugs (Safe Custody) Requirements 1973 to comply with the safe keeping of service users medication. The registered person must ensure that records for the receipt of all medication are available to comply with the safekeeping of service users medication The registered person must ensure that all out of date or unwanted medication is returned to the pharmacy to ensure the safety of service users. DS0000024951.V325333.R01.S.doc 30/06/07 4. OP9 13(2) 31/05/07 5. OP9 13(2) 31/05/07 6. OP9 13(2) 31/05/07 7. OP9 13(2) 31/05/07 8. OP9 13(2) 31/05/07 Abbeymere Care Centre Version 5.2 Page 28 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP10 12(4) a & b 13. OP18 13(6) 14. OP22 13(4) a & (5) 23(2) c 13(4) a 23(1)(2)p & (5) 15. OP19 The registered person must ensure that a Controlled Drug Register is available for controlled drug medication in order to ensure accuracy of controlled drug records. The registered person must ensure that there is a documented protocol available which describes the care to be given to residents who could become agitated or aggressive. This must include details for the administration of medication prescribed ‘when required’ for behaviour management. The registered person must ensure that staff sign the medicine charts for the administration of medication or an appropriate code is documented to show the reason why medicine was not administered to ensure accuracy of medicine records. The registered person must ensure use of subjective statements as to resident’s behaviour must be stopped. Use of such terms that imply a resident is ‘nasty’ compromise dignity and are not factual. The registered person must ensure that staff comply with the homes jewellery policy so as to ensure that residents are protected from potential injury. The registered provider must ensure that all hoists are serviced at least six monthly so as to ensure that they are safe to use with the residents. The registered person must complete risk assessments relating to hazards within the home as identified in the last Environmental Health Officers report. If there are difficulties in DS0000024951.V325333.R01.S.doc 31/05/07 15/06/07 20/05/07 30/06/07 30/05/07 30/05/07 30/06/07 Abbeymere Care Centre Version 5.2 Page 29 addressing the above the registered person should contact Environmental Health. This is to include resident’s access to potentially hot surfaces such as radiators. The registered person must review the staffing arrangements in the home so that that there are sufficient staff available at all times to meet the assessed and changing needs of more dependent residents. The registered person must ensure that all staff employed by the home are subject to an enhanced disclosure by the registered provider, not a previous employer. This practice must be implemented to ensure residents are safeguarded. 16. OP27 18 (1) a 15/06/07 17. OP29 19(1) b Schedule 2 30/06/07 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 OP7 Good Practice Recommendations Staff should be provided with appropriate training in care planning so that they can better draw together care plans in conjunction with the individual resident, this so it is clear to all staff as to how they are to meet individuals needs. It is strongly recommended that any hand- written medicine charts are double- checked and signed by a second member of staff to agree that the medication details recorded were correct. It is strongly recommended that all service users allergy status is documented on their medicine record charts in order to ensure the safety of service users. 2. OP9 3. OP9 Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 30 4. OP9 5. 6. 7. OP9 OP30 OP31 8. 9. OP31 OP33 It is strongly recommended that the date of opening of all medicine containers should be recorded and any balances of medicines carried over onto a new medicine chart in order to undertake a medicine audit. It is strongly recommended that creams and ointments are stored separately from tablets and liquid medicines to prevent possible cross contamination. Staff should be provided with training to better equip them with the needs of more dependent residents with depression and dementia. The manager and all senior staff are to be provided with job descriptions that enable them to fulfil their duties. There should be clear criteria laid down that specify the minimum level of competence for any person that is left in charge of the home in the absence of the manager this to assist with clear lines of accountability and the responsibilities of this position. The manager must commence and attain a qualification in management equivalent to the Registered Manager’s Award (NVQ level 4 in management). To continue developing the homes quality assurance systems so that it becomes an effective management tool and assists in ensuring the service is run in the best interests of the residents. Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands 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. Extracts may not be used or reproduced without the express permission of CSCI Abbeymere Care Centre DS0000024951.V325333.R01.S.doc Version 5.2 Page 32 - 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. 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