Inspection on 21/02/08 for Abbeymere Care Centre

This inspection was carried out on 21st February 2008.

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 21/08/07

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

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 4QJ Lead Inspector Mr Jon Potts Unannounced Inspection 21st February 2008 09:00 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.V360170.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.V360170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeymere Care Centre Address 12 Eggington Road Stourbridge West Midlands DY8 4QJ 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 abbeymere@abbeycare.org Karelink Limited Vacant 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.V360170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2007 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 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, which are from £380 to £398 per week. This does not include extra services such 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. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people that use this service experience adequate quality outcomes. This unannounced inspection took place over one day with three inspectors involved, one a pharmacist. Evidence of the homes performance against a number of key standards (especially those where the home performed poorly at the time of the previous inspection) was measured through focusing in depth on the care received by three residents, this involving looking at care documents, talking to the residents themselves, staff, management, observation of what was happening in the home and examining a range of other documentation. What the service does well: What has improved since the last inspection? There has been improvement since the last inspection, most notably in the difference in the outlook of the staff that were found to be far friendly, with a lighter atmosphere noted within the home. There has been improvement in the homes record keeping with improving care plans, risk assessments and records related to monitoring the care provided to residents. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 6 There has been continued improvement in the way the home handles medication so a to ensure administration, storage and control of such is safer, protecting residents. The provision of day to day activities within the home has improved with those advertised happening in practice, although community access needs to be better. There have been a number of improvements to the physical environment with redecoration of resident’s communal and some private areas making them airy and brighter. There is a new large screen plasma, wall mounted TV with freeview in the large communal lounge which makes viewing easier for residents. The home also has new sit-on weighing scales (making weighing of residents easier and more accurate). The kitchen has also been refurbished, this not having a direct environmental impact for residents, but making this an easier to clean, and thereby safer area for food preparation. The deputy, now the acting manger, now manages the home. The response of the acting manager to the inspection was far more involved than the previous managers, and she showed an interest in what was raised by us as opposed to what was very non-committal attitude previously. What they could do better: Despite improvements there are still many areas where the home could do better, the following illustrative of some of these: • There is still much scope for improvement in records that ensure the effective delivery of care including expansion of care plans and risk assessments. • Residents handling of medication needs to be effectively assessed and medication records need to carry reference to any allergies individuals may have. • Activities need to further improve in accordance with the wishes expressed by residents at meetings, this to include a more community focus. • Staffing levels need review so that there are sufficient staff available to meet all of the residents needs including health, stimulation and activity. There also needs to be sufficient staff to allow the acting manager dedicated time to manage, rather than having to fit this in when possible. Staff recruitment practices also need to be consistently more robust to ensure new staff are safe to work with vulnerable adults. • There are a number of areas around the home where there are potential risks, such as frayed carpets that present tripping hazards, excessively hot radiators surfaces, broken headboards and so on. Risk assessment of equipment such as bedrails whilst in place needs to be better to ensure safety. • There are areas where staff knowledge and skill could be improved in significant areas of practice beyond the mandatory areas required. One example is pressure area care so that staff are aware of the need to be vigilant as to the operation of such as pressure relieving equipment and the part they play in promoting resident’s tissue viability. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 7 • Staff need to be more aware of the need to ensure they knock resident’s bedroom doors prior to entry. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbeymere Care Centre DS0000024951.V360170.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.V360170.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): 3, 4 & 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents are given the information (in standard written format) they need to make an informed choice about whether or not they want to live in the home, this supplemented by the offer to view the facilities. Before they are admitted to the home new residents are assessed this followed by assurances that the care service can meet their needs and wishes. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the care the home offers. This guide was revised in September 2007 but due to changes in management will need further revision to ensure it’s accurate. The guide is given to individuals Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 10 at the point they are considering the suitability of the service for their needs, this in a standard written format. We case tracked one resident who had recently been admitted to the home. There was a comprehensive assessment, which had been completed by the registered provider prior to the resident coming to view the home (with their relative). Despite the placement been funded by the local authority there was no copy of a social worker’s assessment and care plan. The provider stated that they were told by the social worker that due to circumstances he would not need one, this incorrect. Information sent by the provider to us post inspection in regard to information that was not available from the local authority was found to be in respect of another person and not the resident whose care records were examined. It was pleasing to see that the provider had explored the personal preferences of the prospective resident at the time of the initial assessment however. Discussion with a relative of a resident admitted to the home last year evidenced that there was the opportunity for the individual to sample the service, and the relative stated that they had been given all the information they needed pre-admission. There was a letter from the registered provider to the person’s relative stating that the care home could meet assessed needs, this also confirming that a service user guide, brochure, Dudley advocacy services and a summary of the last inspection report was enclosed. There were details of the fee levels and a copy of the contract of residency was available at the home. The tone of the letter was warm, friendly and helpful. This and previous inspections have identified that residents admitted to the home with such as a mental illness and specific health needs would mean that staff have training in the appropriate areas of care. Whilst some staff have received training in dementia, there is still a need to be more pro active in identifying the exact training needs of staff based on the needs of the resident group. Where there is potential for challenging behaviour staff should also have training to assist them to deal with this. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is improving although there is scope to continue this so that it meets all their individual needs. The principles of respect, dignity and privacy are more apparent within the homes practices. Overall medication was being carefully handled to ensure that people who use the service were safeguarded. EVIDENCE: We looked at three care plans in some depth and it was noted that these were in place for all three unlike previously where they were not in place for some residents. The plans seen were relatively basic and focused on the basic personal and healthcare issues of the residents concerned, although discussion with staff and observation did indicate that those areas checked were accurate. This would seem to indicate that the input of the provider has assisted with improvement (as documented in staff meeting minutes and reports of his visits Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 12 to the home) although there is a need to develop the plans to cover the full range of residents needs and preferences in terms of social and emotional aspects of care, as well as personal and health. Discussion with the acting manager did indicate that some support such as training in care planning would be of value in developing her skills and knowledge, this so that she could then pass this knowledge on to the staff team. It was promising to see that there has been work to develop areas within the plans in respect of communication and risk (such as choking, nutrition and use of specific aids). More regular review of plans was also noted and there was some evidence of agreement with the resident or their representative. Whilst there is still much to do to bring the care plans to a level where they could be judged as good, the efforts of the management team over a relatively short space of time since the last inspection is recognised. One resident tracked was seen to have a rare health condition, and whilst information had been obtained from the internet for staff appraisal the plan did not always consider how the progression of this disease may impact on the care the home would need to provide with the impact on physical ability and emotional difficulties. It was noted that whilst risk assessment was in instances basic, it was sufficient, this a clear improvement and there was clearly a correlation between falls and physical adaptation to one residents room to counter this. There was also for example a clear correlation noted between nutritional risk assessment and the frequency of weighing of residents, this assisted by the recent purchase of sit on scales. There was clear documented evidence of residents receiving contact with health professionals where as at the last inspection this was not always the case. Residents were seen to have had recent contact with dentists, chiropodists and opticians and one resident had been referred to and seen a dietician. There was clear evidence that some residents where needed were having regular contact with district nursing services in respect of pressure area care. Discussion with the district nursing service evidenced that the acting manager was prompt at referring any issues of concern to them and asking for their advice although there was some concern that staff needed to be more aware of monitoring of pressure relieving equipment in that if there was a perceived problem (such as warning beeps or deflation) that the district nurses needed to be informed immediately. In addition staff needed to ensure that the pressure relieving equipment was not compromised by such as a duvet coming between the surface and the residents skin, as had occurred on one occasion. In addition there appeared to be some confusion as to the expected turn frequencies for a resident with pressure areas, with staff turning three hourly where as there was suggestion from other sources that this should be two hourly. There was however a turn and fluid chart in place for this resident, this seen to be completed on a on –going basis by staff. There was no evidence Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 13 that these factors had resulted in skin breakdown in these instances however, although this does suggest that this is one area in which staff would benefit from structured guidance or training. It was pleasing to see that advice has now been sought I respect of the frequency of blood monitoring for one resident and this is now documented within that persons care plan. We noted that the atmosphere within the home was notably more upbeat that at the time of previous visit with staff coming across as more friendly and this having a positive impact on residents. Staff spoken to were clear as to how they could promote residents privacy and dignity and comments received bore out there was perceived improvement noted by professionals visiting the home, for example residents are asked what they want. They were occasions noted where staff did not knock on bedroom doors, this based on observation and residents comments, and care needs to be taken to ensure that gaining permission to enter a residents room is embedded in day-to-day staff practice. A medication policy dated May 2007 was available to ensure that people who use the service were safeguarded. Systems were in place to ensure that medication was recorded when it arrived into the home and also when medication was no longer needed and returned to the pharmacy. This helped to ensure that safe levels of medication were stored within the home. The majority of medication seen was stored safely in locked cupboards. Medication was stored neatly in individual plastic containers to ensure each person’s medication was kept separately, this ensured that medication could be easily located to administer. Daily records of the temperature of the room were available, which were within the correct temperature range for medication storage. During a tour of the premises some external preparations (creams and ointments) were seen stored on the top of a radiator in a person’s bedroom. Some of the preparations were out of date. The independence for the person was respected, however there was no risk assessment available to ensure the safe management and secure storage of medication. The majority of the medicine records seen were well documented with staff signatures to record that medication had been administered to people living in the service or a code was recorded to explain why medication had not been administered. Random checks were done to see that medication had been given as the doctor had prescribed. For example, one check showed that the number of staff signatures on the medicine record chart was the same as the number of tablets that had been removed from the medication container, which shows that medication was being recorded accurately to ensure the well being of people who live in the service. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 14 Care plans and medication records seen were clear and detailed, however it was of concern that one medicine record stated that a person had ‘no known’ allergies, whereas the care plan clearly stated in bold red print that the person was ‘allergic to penicillin’. It means that there was an increased risk that the individuals healthcare requirements were not safeguarded by accurate documentation. Information relating to medication records was available; in particular there were up to date and accurate records in people’s care plans and also in their daily notes. For example, one person had been prescribed a medicine to calm and control their behaviour when required, which had been stopped by the GP. The medicine record, care plan and daily record had all been documented with the relevant information. This means that the medication and healthcare records were up to date and ensured that staff were aware of any changes to a persons medication. Abbeymere Care Centre DS0000024951.V360170.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 12,13,14 & 15 Daily activities are provided, with some improvement in the range of activities of late although the home does not always respond to the wishes of residents in this area, most notably in respect to opportunities for community involvement. There is still scope to promote residents taking more control over their lives although staff are becoming more aware of promotion of independence. Residents are provided with a range and choice of meals that they like. EVIDENCE: It was noted that assessments carried information related to resident’s preferences in regard to their daily routines. This information was not always carried through to individual care plans however. There is a notice board in the lounge which states what activities are going to be provided each day. On the day of our visit the planned activities were nail polishing and a birthday party in the afternoon. We spoke to one resident that Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 16 showed us her nails, which had been painted which she was pleased with. There was also seen to be a range of party foods brought out during the afternoon for the planned party. There was seen to be an activity diary which records what is offered and which residents participated, this over the last month showing that the following activities had taken place: films, hairdressing, walks in garden, newspapers, TV (There is a new large flat screen TV mounted on the lounge wall this easier for residents to see), skittles, sing a long, board games and hairdresser. Representatives from a local church visit the home and one resident stated that they went to church with relatives. It was noted that a corridor area was sufficiently wide to have a library area, this containing large and ordinary print books changed regularly by mobile library. We saw some residents enjoy reading. The last residents meeting showed in minutes that residents would like an exercise person, this not yet organised based on activities book and what the acting manager told us and walks around the village, for which more staff are needed (one staff member told us that this was not possible with current staffing levels). We chatted to a visiting relative. They told us that their relative was content with the level of activity at the home although this was due to the fact they did not like to do much. Comment was made that there was no restriction on visiting times and staff were good at keeping them up to date with developments. We saw and heard of some positive practice regarding how residents’ are enabled to exercise choice over their lives. Those residents who were able to articulate their wishes were responded to appropriately by staff although there does need to be further work on communication plans, although there was evidence that there was development of these, and staff spoken to showed some awareness of how they should respond to residents whose communication was limited. Assessment of where there maybe limitations on residents due to capacity also needs to be considered in line with the expectations of mental capacity legislation. There are written menus on display for meals (not pictorial), including supper on a notice board near the dinning area. The staff also write the daily choices on a larger board. Breakfast is served at 08:00 and this was finished and cleared away by 09:00 on the day we visited the home. We were told by the acting manager, residents and staff that the night staff get all residents up and give them a cup of tea and biscuits before breakfast. Staff spoken to stated that some residents liked to get up early, but were asked if the were sure and were reminded of the time to ensure this was the case. The choices offered for lunch corresponded with the choices recorded on the menu. We have seen the chef go around the home to ask residents what option they wanted for their cooked midday meal. One relative also stated that having seen staff feed a resident they were pleased to see them offer alternative when they did not Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 17 wish to eat what was offered. The acting manager explained that the home has staggered mealtimes and people who requiring feeding, there are three at the present time, can be fed in an unhurried way by the three staff on duty. The three residents had their cooked lunchtime meal at 12:00. The staff are then available to assist the remaining residents, and the staggered lunches also ensure there is more space available in what is a fairly compact dining area. We observed the lunchtime cooked meal, whilst viewing records in the reception area, so as not to intrude in the dining area, which only has seating for the number of residents taking their meal at 12:30pm. The meal looked and smelled appetising and residents cleared their plates, saying that they had enjoyed the meal, “it was a lovely dinner”. We have talked to the chef, who has been employed at the home since November 2007. He holds catering and food safety qualifications. NVQ 1 & 2 in catering and Hospitality, Intermediate Food Hygiene completed in February 2007. He has told us he devises the menus every 4 weeks and frequently revises them according to residents’ likes and dislikes. He is knowledgeable about the residents and special dietary requirements. He had been to a resident’s room to discuss the day’s choices because of a condition, which makes digesting certain foods difficult. He told us that the food is home cooked, what we saw confirming this; we have seen the birthday cake he has made for one of the two residents who had a birthday on the day of the inspection visit. The other resident did not want a cake. He has told us that the majority of residents prefer ‘traditional’ British food, with just a few who will try other food such as spaghetti bolognaise. There are food stocks including, some fresh items, vegetables and fruit. The chef has told us he is able to purchase whatever food stocks he needs to produce planned meals to meet residents’ needs and choices. It was noted that the only milk supplied is UHT long life skimmed milk. Consultation with residents as to whether they would prefer full fat milk maybe a consideration, this as the latter would be more appropriate for fortifying foods for those with poor appetites. We did see that the home carried a stock of prescribed food supplements as referred to in care plans for residents with poor appetites. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Those involved with the service have access to a complaints procedure and management are said to respond appropriately. The home has procedures that outline how adults should be protected from abuse, and staff are aware of these. Staff knowledge in respect of some areas of safeguarding could be improved though. EVIDENCE: There is a complaints procedure, which is displayed. This is not produced in alternative formats although was seen to be on display in the foyer in larger print. There was evidence that residents and relatives are provided with a copy of the homes complaints procedure at the point of admission and there are residents meetings held where the resident groups views are sought. We spoke to a relative who stated that they knew who to complain to (if needed), with comment to the fact that the acting manager and director were approachable. This supported the outcome of collated results of questionnaires to residents and relatives that indicated the perception was that the home was good at responding to complaints. There was stated to have been no complaints received at the home since the time of the last inspection. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 19 We saw the homes policy on adult protection, this satisfactory and containing an added addendum that links it with the local social services departments safeguarding procedures which were also seen to be available. Staff spoken to were aware of these and also stated that if there were protection issues they would raise them externally if the provider took no action. Staff had some awareness of what would constitute abuse but we noted that, based on the staff training matrix/training records that many staff have not had training in safeguarding adults for a number of years and would benefit from an update. The proprietor and acting manager have told us that Adult Protection Training is planned and will be delivered by a trainer, who used to provide training courses in a number of mandatory training topics. We have examined training certificates, which do not provide evidence of the trainer’s accreditation or competence to deliver training in the subjects. We requested clarification about whether the proposed Adult Protection training includes the Local Authority Safeguarding procedures and the proprietor stated he intends to check this with the trainer and also request details of accreditation and/or training competence. We also spoke to a care assistant, recently employed and though she has not received specific training relating to safeguarding adults, she is undertaking NVQ level 2 training, which has a underpinning knowledge and a unit relating to abuse. She was keen and enthusiastic. She was observed meeting with an Assessor from Dudley College to discuss her progress, which is very positive. It was noted that one resident whose case file was examined was recorded as having presented ‘aggression’ towards staff, this an expected outcome based on their health. Staff would benefit from some training to assist them to work with challenging behaviour as was raised at the last inspection, this in addition to the dementia care training staff have already received. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Generally the home provides residents with a well-furnished and comfortable environment in which to live this compromised to some degree in some areas require where there is potential risks to safety. There is some improvement in respect of infection control practice although this could still be much better. EVIDENCE: We have undertaken a tour of the premises including a sample of residents’ bedrooms with their permission. The director and acting manager has shown us a plan of how they intend to maintain, redecorate and refurbish the home. The audit did not document all issues needing attention and there was no Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 21 reactive book or record of on-going minor repairs such as the following that were noted: • • Risk assessments for bedrails did not assess compatibility with mattress, or show regular documented checks. In the corridor from dining room to lounge, the carpet was worn and has a join, which is fraying, a potential tripping hazard. This was also the case in the reception/dining room entrance where the carpet was fraying from gripper. There was such as broken headboards in some bedrooms with the bed the wrong way in cases leaving the fitting for headboard exposed, with a potential risk of causing injury to legs. It was also noted a number of wardrobes were unsecured this presenting a potential risk of their falling forwards. On the 1st Floor bathroom there is a full size bath that has a worn area, showing corrosion and rust, as in the case on areas of the frame of bath seat. The exterior of Home had a number of ground floor wooden window frames in poor condition, rotten, cracked and with heavily flaking paintwork, this not documented on a timed maintenance programme. We have discussed the risks posed by exposed pipe work and unguarded radiators in various parts of the home, which are excessively hot to touch with the registered person, who has given a commitment to take action to minimise the risks as a priority. • • • • The acting manager has told us that the previous registered manager’s spouse undertook the maintenance of the home and the intention is that her spouse will undertake a similar role on a part time, self employed basis. We have stressed the need for appropriate checks and clearances, such as CRB and copies of insurance to be available at the home, as they should be for any other contractor such as the hairdresser and private chiropodist. We note that a number of improvements have been made since the last inspection visit these including the redecoration of the dining room, which feels more airy and brighter, refurbishment of kitchen, new carpets in 3 bedrooms, new extra large plasma, wall mounted TV with free-view in the large communal lounge, new sit-on weighing scales, new washer and tumble dryer. We have looked at the kitchen, which has been completely refurbished and is in good order with a variety of nutritious food supplies. We have highlighted the need for vigilant food safety and risk assessments for high-risk equipment such as the electric deep-fat fryer and meat slicer / knives. The laundry is sited at the side of the premises on the ground floor away from food serving or preparation areas. We have discussed with the director / acting manager that the current facilities are not adequate, for example there are no appropriate sluicing facilities and the new washing machine does not have a readily identified sluicing cycle, although it has a pre-wash programme. We have Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 22 discussed this issue with the director, who insists the machine has a sluice cycle; we have requested that documentary evidence be obtained from the manufacturer as clarification. There is also a new tumble dryer. The flooring and walls still do not present easily cleanable, water impermeable surfaces. There is only one sink, which states it is designated for hand washing only but there are no hand washing signs to remind staff of good techniques. There is a supply of red disolvo sacks but we have been told the staff toilet is used to hand sluice soiled linen. There are extraneous items, such as the ironing board, which must be removed to promote improved infection control. The home does not currently have a copy of the Department of Health Infection Control 2006 guidance for effective infection control. There is no laundry procedure, cleaning schedule or infection control guidelines displayed in the laundry area. It was noted the disposable gloves available to staff are polythene and are not substantial enough for dealing with bodily fluids and some chemicals, the director advised to seek advice from the Health Protection Agency and also obtain a copy and take account of their policy for use of disposable gloves. We have been told that care staff undertake laundry duties over the 24 day and that the majority of staff have received infection control training which was borne out by the staff training matrix and confirmed by those staff we spoke to. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 23 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 poor This judgement has been made using available evidence including a visit to this service. The staffing levels do not always meet the needs of the resident group. Although staff are qualified, they require further training to meet the specialist needs of the residents. There are also shortfalls in recruitment and induction that have the potential to compromise resident’s safety. EVIDENCE: We have looked at the AQAA submitted by the provider at the time of the previous inspection as part of the inspection planning and we have looked at the staffing rotas in place at the home during the inspection visit. There is 10 staff including the acting manager, who tells us she works most shifts as part of the care team, with a few managerial hours usually at the end of her care shift or when she works late shifts. The rota shows the acting manager’s usual hours from 9am – 4pm, though she sometimes works from 9am – 8pm. The staffing levels are 2 care assistants from 8am –9am (one senior) though this is not clearly identified on rotas. 3 care assistants from 9am – 8pm including the acting manager for 6 days each week. Staff work varying shifts, examples are 8-2, 8-4, 8-8 and 4pm-8pm. We are told that there is always 2 wakeful night staff on night duty. We have been told by the acting manager and chef that he works 8:00am – 2:00pm but the rota for January and Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 24 February show his hours as 9:30am – 1:30pm (this has only been identified through analysis of copies of rotas following the inspection visit and we have not discussed the detail of rotas during the visit, as the acting manager and proprietor have been very busy most of the inspection day). There is a cleaner 09:00- 12midday Monday to Friday, we are told that the care staff do essential cleaning at weekends and when cleaner is away. The acting manager has told us that the cleaner is due to leave in a weeks time, she stated that there are interviews planned for that week and existing cleaner is willing to stay on until new person is CRB cleared. Whilst staffing has seemingly increased since the last inspection so has the dependency level and number of residents. The home has a chef working 8-2.00 six days (7 days a week at present) care staff expected to undertake catering duties when chef is off duty, this once again potentially impacting on care hours. The rotas also show that 4 staff do a mix of days and night duties and are sometimes detailed to work an afternoon shift following a night shift and in 3 instances work a 4-8 shift in the middle of a ‘run’ of night shifts. This may mean that staff potentially do not have sufficient rest times between shifts posing risks to themselves and residents. We have discussed the current residents’ dependency levels with the acting manager. We have been told that there are 3 residents who need to be moved using a hoist, needing two staff, 1 resident cared for in bed who has pressure sores (we established from the district nurse these are grade 4 – the acting manager was not aware for the need of a regulation 37 notification to CSCI). 1 resident needs 1 staff to walk with her at all times, 2 residents bath independently, 14 residents need assistance of at least 1 carer for bathing but 12 residents need two carers for bathing and toileting. 3 residents have to be fed. Although the director and acting manager stated that three care staff are sufficient to meet residents needs, the evidence from this inspection visit indicates that the staffing levels are depleted by ancillary and some managerial tasks and that routines are not always flexible and some residents needs and wishes are left unmet. It has already been identified that staffing levels impact on the provision of social activity. We have looked at 4 staff files to assess recruitment practice and personnel records. The home has an adequate recruitment procedure although there are shortfalls in recording and processes found to be being evident as detailed: • One staff member was employed with only one reference and another was subject to a reference that was not complimentary, and an alternative reference was not sought, not was there any documented discussions as to the reasons. • One of the four staff had not signed a disclaimer re criminal convictions and at the time of the visit there was no risk assessment found to show how the home minimised risks as they were employed prior to receipt of Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 25 • an enhanced disclosure. A copy of the same has however been forwarded to us post inspection, this found to be satisfactory. One staff member that had signed a disclaimer saying they had no criminal convictions was subsequently (on receipt of the disclosure) to have a recorded offence and there was no evidence that this matter had been dealt with in respect of the person’s integrity and honesty. There was no evidence that residents are involved in the recruitment of staff. The evidence suggests that there maybe have been an emphasis on filling vacancies rather than getting the right person for the role. There are 8 staff with NVQ 2 or above, 4 staff with NVQ 3 care award this taking the home over the 50 level of qualification that would be expected. We have examined staff training and the director and acting manager have given us a copy of the staff-training matrix, which documents staff training. This shows that the majority of staff have training in the core mandatory areas: or have the same booked (such as moving and handling, food hygiene, first aid, health and safety, infection control and fire safety) but require training in others areas related to the specific health care of the residents at the home (see comments earlier in this report) as well as diversity and safeguarding. From discussion with the acting manager and director there appears to be recognition of this and the majority of staff have received training in dementia care. The majority of training at the home was carried out by the training provider referred to earlier in this report, (see comments complaints & protection section), and their competence to deliver training topics in not clear. The proprietor has told us that the trainer is bringing evidence of accreditation to the home; we strongly recommend that copies of documentation be held at the home. We have been told that training relating to aggression in workplace is due to take place at the home on Friday 22/2/08 and Fire training for all staff is also booked for February 2008. Examination of staff files showed inconsistent practice in respect of staff one – to- one supervision and there was no clear evidence that new staff have other that a basic induction, not one that fulfils common induction standards that are agreed by nationally by Skills for Care. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Changes in management at the home are resulting in some improvement although there has been a limited time for the acting manager to fully implement and address all issues outstanding from previous inspections. Appropriate support, training and resources have the potential to improve the overall performance of the home. EVIDENCE: Sue Batham is the acting manager in post 2 months. She stated that she will be commencing the Registered Managers Award on the 25/2/08 with Affinity Training, a distance learning course, with Tutor input, at the home, which she stated suits her learning style. She has NVQ levels 2 & 3. She has no allocated Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 27 managerial hours at present and works 40-50 hours each week, which she stated she was happy with. She states she tries to have a few hours for management / administrative duties at the end of a shift or whilst working on the late shifts. Based on the outcomes of this inspection it is indicative that Mrs Batham, with the support of the company director is trying to effect some positive changes, although is hampered by limited management time and the number of improvements needed. With the allocation of sufficient time, support and training (such as the RMA and care planning as examples) there is every possibility that the acting manager could be successful in improving outcomes at the home, and it was promising to see that there was a clear interest, recognition of personal responsibility and commitment to the service on her part. She stated she has responsibility for the staff rota and can call in extra staff as needed; she gave the example of when the optician visits the home, although does need additional staff to fully met current resident need. She states she receives support and formal supervision from the director of the company Mr R. Sahadew, although her personnel file and supervision records are not held at this home. The registered provider has shown us a newly purchased quality assurance system based on the Care Homes Regulations and National Minimum Standards, which he intends to use in this home. He states it is advocated by the West Midland Care Association and demonstrates self-assessment and evaluation and incorporates formal surveys and meetings with residents. The home has used resident questionnaires in December 2007 and stakeholder questionnaires in March 2007 and the collated results from these do indicate that the residents and relatives see the home and service in a positive light. Discussions have taken place relating to the new Regulation 24, requiring the home to submit an annual AQAA on request by the CSCI and it is recommended that the registered manager proactively use this as an additional quality assurance tool. In addition the evidence to support statements made in the AQAA need to be more detailed, as the evidence will be tested and verified during future inspection visits. We have seen some evidence that mandatory training is being sourced and provided for staff on an on-going basis, though we have strongly recommended that the accreditation and competence of training providers be sought and documented as started earlier in this report. There was seen to be appropriate safeguards in place in respect of resident’s valuables and property, with records relating to monies in safekeeping satisfactory. The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. However there is no evidence of a Landlords Gas safety check for the long unused wall mounted gas fire in the dining area. This needs to be actioned. We Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 28 have looked at the 57 recorded accidents involving residents since the last inspection and we have seen copies of the accident analysis and evaluation completed by the acting manager, with evidence that there has been a positive use of such to improve outcomes for at least one service user. There was seen to be a smoking free sign on front door and staff and a resident smoke outside on patio or under covered area at side of home. There was reference in care documentation to the resident also smoking in their bedroom on occasions, this a practice that needs to be risk assessed due to the possible exposure of staff to second hand smoke. This matter should be discussed with environmental services. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 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 2 X 1 Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) Requirement 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 consistently 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 fully met by the 31/03/07. We have however seen a marked improvement over the last six months hence the extension of the timescale to fully address the above. The registered person must 15/04/08 ensure that suitable arrangements must be made to ensure that medicines stored in a person’s room have been risk assessed to ensure that people who use the service are protected from harm. The registered person must 30/04/08 DS0000024951.V360170.R01.S.doc Version 5.2 Page 31 Timescale for action 01/07/08 2. OP9 13(2) 3. OP19 23 Abbeymere Care Centre 4. OP27 18 (1) a ensure that any areas of potential risk to residents presented by such as exposed hot radiators, broken headboards, frayed carpets are identified and made safe. 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. This is a repeated requirement, which was to have been met by 15/6/07. Despite some increase in staff this as been matched by increases in resident dependencies so is still an issue. 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. This is a repeated requirement, which was to have been met by 30/6/07. Dementia care training has been provided since the last inspection. The registered person must ensure that recruitment practice is consistent and sufficiently robust to ensure that new staff are safe to work with vulnerable adults. The registered person must ensure that all of the bedrails currently in use are assessed and make sure that they are DS0000024951.V360170.R01.S.doc 30/04/08 5. OP27 18(1)(c) 01/07/08 6. OP29 19 30/04/08 7. OP38 13(4)(c) 30/04/08 Abbeymere Care Centre Version 5.2 Page 32 suitable for the beds they are being used upon. Where appropriate bedrails must be replaced in order to reduce the risks to residents including the risk of entrapment – this is to promote the health and safety of residents. This is a repeated requirement, which was to have been met by 22/8/07. We have however seen some efforts over the last six months to address this hence the extension of the timescale to allow expansion of the risk assessments in place. So that such as compatibility with mattress, regular documented checks can be shown. 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 OP1 Good Practice Recommendations To review the statement of purpose to ensure that it accurately reflects the service provided by the care home and complies with the requirements of the Care Homes Regulations 2001. (i.e. change of manager) It is suggested that care plans are reproduced in formats and styles, which are accessible to residents. The registered person needs to ensure that staff are aware the need to be vigilant as to the operation such as pressure relieving equipment and the part they play in promoting tissue viability. The registered person should ensure that any known medication allergy is clearly recorded on the medicine record sheet in order to ensure peoples healthcare requirements are safeguarded. The registered person should ensure that staff always knock bedroom doors prior to entering a residents room. DS0000024951.V360170.R01.S.doc Version 5.2 Page 33 2. 3. OP7 OP8 4. OP9 5. OP10 Abbeymere Care Centre 6. OP12 7. 8. OP16 OP18 9. 10. OP19 OP26 The registered person should ensure that appropriate recreation/stimulation is provided everyday to meet the assessed needs and preferences of all residents thereby promoting their welfare, this to include build on opportunities for residents to participate in the local community according to their wishes and preferences thereby providing them with a more stimulating lifestyle. The registered person should consider producing the complaints procedure in varying formats. The registered person should provide all staff with training or updates in safeguarding and protecting adults, this to include guidance and training in Whistle Blowing procedures. The registered person should consider replacing the heavy weight dining chairs for lighter versions thereby reducing the risk to residents. The registered person should ensure that there is: A written cleaning schedule for the home, which should include the regular deep cleaning of carpets. A written laundry procedure and to keep a supply of COSHH information available in this area. A laundry area free of any extraneous items such as ironing board etc. A regular programme of washing mop heads at thermal temperatures (which should be included on the cleaning schedule). That the practice of hand sluicing in the staff toilet ceases and any unavoidable hand sluicing is risk assessed and kept to a minimum in a more appropriate location, which the registered person must identify. The registered person should ensure that senior staff are clearly identified on rotas. The registered person should support staff to undertake a range of specialist training which includes dementia, depression, tissue viability, diabetes, mental illness, continence management, dealing with aggression and person centred planning. The registered person should ensure senior staff are 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 DS0000024951.V360170.R01.S.doc Version 5.2 Page 34 11. 12. OP27 OP30 13. OP31 Abbeymere Care Centre 14. OP33 15. OP38 16. OP38 the responsibilities of this position. The registered person should 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. The registered person should ensure all incidents that affect the well being of residents, including serious risk to health due to tissue breakdown are reported to the Commission for Social Care Inspection in line with guidance issued. The registered person should ensure that then practices in respect of smoking within the home are discussed with environmental services. Abbeymere Care Centre DS0000024951.V360170.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V360170.R01.S.doc Version 5.2 Page 36 - 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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