Inspection on 19/10/06 for Abbeymoor Care Home

This inspection was carried out on 19th October 2006.

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

Abbeymoor Care Home 17/09/09

Abbeymoor Care Home 28/11/08

Abbeymoor Care Home 30/06/08

Abbeymoor Care Home 27/07/07

Abbeymoor Care Home 31/01/06

Abbeymoor Care Home 16/08/05

Abbeymoor Care Home 19/10/04

Abbeymoor Care Home 21/04/04

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Abbeymoor Care Home Sherwood Road Worksop Nottinghamshire S80 1QW Lead Inspector Linda Hirst Key Unannounced Inspection 19th October 2006 10:30 X10029.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 Abbeymoor Care Home DS0000059941.V313006.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 and Care Homes for Adults 18 – 65*. 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. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeymoor Care Home Address Sherwood Road Worksop Nottinghamshire S80 1QW 01909 475660 01909 480998 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) Care Companions Healthcare Ltd Rosa Elizabeth Arthur Care Home 25 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number disorder, excluding learning disability or of places dementia (6), Old age, not falling within any other category (19), Physical disability over 65 years of age (19), Terminally ill (19) Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4 of the beds may be used for service users over the age of 60 years There will be a Lead, Head of care, for the eating Disorders unit on site between the hours of 08:00 and 18:30 MD Category can only be used for Younger adults (Eating Disorder) age 18 to 65 31st January 2006 Date of last inspection Brief Description of the Service: Abbeymoor is a care home that provides residential, nursing and specialist care to adults from the age of eighteen. There are 25 places and services are offered to both female and male residents. The care home is registered to provide specialist care and support for up to six adults between the ages of eighteen and sixty-five, and 19 places for older people, people with dementia and people with a physical disability over 65 years. Six beds provide a specialist Younger Adult unit for women and men who have a diagnosed Eating Disorder. The home can offer short term and long term residential/nursing care. Abbeymoor is located close to shops and local services (about 500 metres) and there is access to public transport including a train station (about 500 metres). The home is detached and set in its own grounds with a car park to the front of the building. The building is adapted to cater for the needs of people with mobility problems and all areas within the home are accessible. The Younger Adult unit has its own newly installed kitchen, dining and lounge area, separate from the communal facilities offered to service users residing within the main building of the care complex. The fees range from £277 per week for residential care to £351 with £83 nursing top up per week for residents receiving nursing care. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (Commission for Social Care Inspection) is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 7 daytime hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. The residents who were “case tracked” were not able to help by giving an opinion about the care provided. One resident who could express opinions was spoken with and two sets of relatives gave their opinion about the service. Three members of staff and the manager were spoken to as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. An interview was held with the home’s pharmacist who was inspecting how medicines are stored and given out to make sure this was done safely. 11 service user questionnaires were returned and inspected before the visit to the home. The main areas of concern expressed were around activities and complaints. Although the home is registered for a mixed category of resident, the younger adults wing is currently unoccupied, and there are no residents at the home who are under 65 so only the older persons standards have been assessed. What the service does well: The manager makes sure that everyone who comes to live in the home has been assessed to make sure the staff can meet their needs. The residents’ health needs are properly looked after and provided for. Medicines are safely stored, given out and disposed of at the home so that residents receive their medication as prescribed by their Doctor. The staff treat residents with dignity and respect and are very caring towards them. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 6 Relatives are welcomed into the home and are kept up to date with any changes. They can approach any member of staff to talk about their relative and they will get a good response. Although the people living at the home have Dementia, the staff use imaginative ways to offer them choices and they respect the decisions they make about their lives. The home is clean, tidy and fresh and provides a pleasant environment for the people who live there. The staff understand their roles, are caring and approachable and work well together as a team to meet residents’ needs. The manager is qualified and experienced and relatives think she is honest and approachable. The residents’ money is well looked after and good records protect their interests. What has improved since the last inspection? What they could do better: Care plans could give staff a more rounded picture of the residents, especially as most of them have Dementia and cannot give an accurate account of their past life and interests. Residents or their relatives could be more involved in developing these plans so that they know how staff intend to help the resident. The level of activity in the home is poor. There is not enough happening to stimulate and interest the residents and because they have Dementia, most people cannot find their own entertainment. This is not acceptable and needs to improve to make sure that residents with Dementia have their needs properly met. The staff do not know enough about residents and their sexuality and the policy of the home is not very detailed and does not help staff understand the issues involved with this area of care. The arrangements for dining could be improved. At the moment most residents remain in their armchairs with tables over to eat their meals. This cuts down on their chances to sit together and socialise and also stops them from getting up and having a walk after sitting for a long time. The home could develop a Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 7 menu, and make sure that this is given to residents so they can choose any alternatives which should also be recorded as proof that the residents get what they would like to eat. Some residents do not know how to complain and the process to be followed is not widely publicised in the home. The manager must find ways to let residents and their relatives know how they complain and who to. The staff do not know enough about abuse and how to recognise and stop it. They must stop putting tables in front of the residents sitting in their armchairs as this stops them having the freedom and choice to move around and is also an obstacle which they may fall over if they try to get up. The manager must make sure that the programme of redecoration and repair in the home carries on to provide a more comfortable environment for the residents. The staffing levels are not high enough to make sure that all of the residents’ needs are met and it is suggested that these increase. The manager must make sure that she has proof that nurses are registered to work with vulnerable people and that all staff are checked for suitability for working with the residents to make sure they are protected from harm and abuse. The manager needs to check what training the staff have done and what they need to make sure that they are able to do the jobs expected of them properly. The owners need to do a thorough check of the quality of the service being provided to the residents at least once a year to make sure that the home runs in the best interests of the people who live there. Safety checks and servicing must be done promptly and when they are due to make sure that the home is a safe place for the people who live there. 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. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Residents are properly assessed before admission to make sure the staff can meet their needs. EVIDENCE: Three care plans were inspected to check that the residents had been properly assessed before being admitted to the home to ensure the staff could meet their needs. There was evidence in all three of social worker assessments and the manager had assessed two of the three before admission to make sure the home was suitable for them. The one without an assessment by the manager was an emergency admission and a relative of the resident confirmed this so Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 10 there was no time for the manager to assess him ahead of admission. All of the residents seen in the home appeared to be suitably placed at the home. The staff interviewed said that the manager assesses all new admissions and they are given verbal information about new residents and told to read the assessments by the manager and the social worker. They said they feel well prepared for any new residents. They feel competent and knowledgeable about the residents’ needs but they did say they would value some training or information about alcohol related problems and this is recommended. The home does not provide an intermediate care service. This standard is not applicable. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Care plans guide staff on how to meet residents’ needs properly but are not holistic in their approach meaning that areas of need are missed. Health care is assessed and provided for well. Appropriately qualified professionals are brought in to help as needed in order to maximise residents’ health. Medication is safely stored, administered and recorded and residents get their medicine as prescribed by their GP. Residents are treated with dignity and respect. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans were inspected for the residents who were “case tracked” to make sure that their needs were fully assessed and that they give enough information to guide staff properly. The care plans are up to date and are adequate for the purpose offering clear guidance to staff, although it is recommended that they contain more detail about the issues such as social needs and interests, personal history and issues such as sexuality and religion. One of the people who was “case tracked” had been admitted for respite care but a suitable care plan was already in place and was being worked on and added to. Some relatives said the staff had discussed the plans with them, others said this had not happened. There was some evidence of residents’ relatives being involved in care plans, but this was not consistent and it is recommended that there are valid, recorded reasons for people not being involved in this process. However, observations indicate that the staff know the residents really well and respond to their needs in the way the care plan suggests. Staff interviewed said that the trained staff write the care plans and they are told about residents’ needs and any changes at staff handover between shifts. The residents’ health care needs are risk assessed using recognised nursing assessments and where needs are identified a care plan is written to offer guidance to staff. There was evidence of the involvement of psychiatrists, opticians, dentists and chiropodists in the files sampled. The staff confirmed that health needs are assessed by trained staff and that they get other health professionals to visit as needed to make sure that residents remain well. The care staff monitor and report on any changes in residents’ health and care charts are used when residents are cared for in bed to make sure that their needs are reviewed regularly. Relatives who were interviewed praised the health care provided by the home very highly. One said a resident had begun eating and drinking properly since admission, another commented how staff have managed to get their relative’s alcohol intake under control and have improved the condition of his skin. One resident said that he only has to ask to see a Doctor and this is arranged quickly. The pharmacist for the home was doing an annual inspection during this visit and he was interviewed to get his view about the safety of medicines in the home. He said that the policies and procedures were thorough and up to date and that the storage of medication was safe and secure. He said the Medication Administration Records were well kept and give a clear indication of what medication has been administered and when. He had made only one recommendation for improvement, that a lock be fitted to the medication fridge to improve security. He commented that he thought that the staff manage medicines well. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 13 The medication arrangements were inspected and were safe, secure and good systems of recording are maintained to make sure that residents get their medication as prescribed and in a safe way. The resident interviewed, relatives and staff said that medication is given out individually by the trained staff and that they wait to make sure residents have taken their tablets so that they remain well and healthy. No unsafe practice was reported. Residents were observed throughout the visit in their interactions with staff members and were seen treating residents with dignity and respect. Those who needed assistance to eat were helped patiently and sensitively. A resident who was interviewed said that the staff are “lovely,” he said he likes his privacy and spends a lot of time out or in his own room and the staff respect that. He said that staff members never open his mail and if he wants to see visitors in private he can. Relatives interviewed also praised the staff and said that “considering the difficulties” they face, staff do very well and treat residents with respect, maintaining their dignity. Staff demonstrated good levels of awareness around issues of preserving residents’ dignity and respect. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. The level and range of activity provided to residents is inadequate and does not offer enough stimulation and interest resulting in restlessness and agitation. Residents are supported to maintain contact with family, friends and the local community avoiding isolation. Staff encourage and support residents to make choices and take decisions in their day to day lives wherever possible. Residents are given a varied and appetising diet to maintain their health but the current arrangements for mealtimes do not facilitate their choices, nor promote social interaction. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 15 EVIDENCE: Nine out of the eleven service user questionnaires received commented negatively on activities. There is an outstanding requirement about providing appropriate activities for the residents. This requirement has not been met. There is an activity plan in place and displayed but in staff interviewed and the manager admitted that any activities have to be done by the care staff on duty. The staff were observed with the residents throughout the course of this inspection and they were extremely busy the entire time. The needs of the residents are very high, most having some form of Dementia and this means that they need a great deal of reassurance, patience and time. The staff were good at meeting needs people in this area, but it meant that there was no time for anything other than supporting people with their care needs, even when the manager came out to assist staff. For the majority of the time people sat in their chairs without stimulation unless visitors came, and no activities were provided throughout this inspection. The staff confirmed that there is no activity organiser employed and that they try and do activities when they can, in reality they are too busy most of the time to do anything consistently. The resident and relatives interviewed said that activities were not provided regularly, some had not seen any since their relative was admitted. The staffing levels are not sufficient to enable care staff to assume the role of activity organiser/provider in addition to their caring responsibilities. The continued registration for people with Dementia is assessed on an ongoing basis, one of the key areas in this assessment is the provision of an appropriate programme of activities to occupy and stimulate residents who are unable to do this for themselves. The observations from the inspection provide evidence to indicate that family and friends are welcomed into the home, and several people were seen visiting on the day of the inspection. Two sets of relatives were interviewed, they said they are kept informed by staff, are made to feel welcome and can visit whenever they choose. Staff interviewed were positive about the contribution relatives make to the lives of residents but were not clear on issues of sexuality and how to support people appropriately nor of issues of capacity and consent though they thought there would be a policy on the issue. It is recommended that support and discussions take place with staff on this issue and that the policy be more detailed. Staff said that around four people access the community and go to local pubs or shops. If they have time and the weather is nice they will take a service user out in wheelchairs. Some relatives take the residents home with them or out into the local community. The resident who was interviewed confirmed that he regularly goes out for walks, as he does not like feeling “cooped up.” Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 16 Staff gave good examples of how they try and facilitate the choices of people with Dementia, using visual prompts and signs. They always try and offer simple alternatives (E.g. with clothing, toiletries and food) to avoid confusing residents with too much information. One resident has a legal representative who manages her finances; in most other cases relatives assist residents. The resident who was interviewed said that choices are offered, how to spend the day, who to see, what to eat, what to wear and the resident also said that staff members respect decisions made by residents. Lunch was observed during the course of the inspection to look at the diet of residents. There is no designated dining room in the home, although there are two dining tables in the main lounge, only three residents make use of these. All of the other residents sit and eat in their chairs with tables in front of them. This could be a time to assist residents with socialising and to mobilise them and it is recommended that thought be given to changing where residents sit to eat their meal. There were several residents needing some assistance to eat, where direct help was needed the care staff sat beside them and encouraged people to eat sensitively. A meat dish and a vegetarian alternative were provided on the day of the visit. One resident had requested an alternative and what he had chosen was provided. Varying levels of soft diet were provided and adapted crockery and cutlery were available for residents to enable them to eat by themselves. The food provided looked and smelled appetising and the resident interviewed, staff and relatives all agreed that the food is good, and that residents get plenty to eat. Staff said that the residents could ask for any food and they would try and provide it, but there was no choice or menu displayed in the home making it difficult for residents to make informed choices. It is recommended that a menu be devised and that choices and alternatives be recorded to make sure that the residents get what they would like to eat. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. 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 the service. The arrangements for making complaints are not given to residents and relatives in an appropriate way and this prevents complaints being registered and investigated. Residents and relatives feel confident to complain. The staff do not have enough understanding of issues of abuse to properly protect residents from harm, though residents feel safe at the home. EVIDENCE: A concern had been reported to the Commission for Social Care Inspection by a Social Worker about residents sitting all day with tables in front of them. The complainant was concerned that this constituted a form of restraint. On arrival at the home, the lounges were checked and 13 residents were sitting in the lounge with tables in front of them, most but not all with drinks on. Five service users were asleep. After lunch there were still 9 people sitting with their tables in front of them for no apparent reason. This matter was discussed with the manager and staff members who demonstrated a good understanding about issues of restraint but did not consider the tables were used at the home as a form of restraint, but to put drinks on to encourage fluid intake. It was agreed that these should be placed to the side of residents, rather than in front Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 18 of them so that residents can get up if they choose without obstacles in their way. That way their safety and their freedom can be maintained. The complaints procedure is only displayed in the foyer, not in the main body of the building where residents and relatives mainly sit and three people returning service user questionnaires expressed confusion about how to complain. The manager must find alternative ways of making residents and relatives aware of their right to complain and to explain the process so that they can take matters of concern up with her. Staff interviewed said that they write complaints in the book and the manager deals with the issues raised. Minor concerns are not recorded (E. g. missing laundry). The resident and relatives interviewed said they had never complained but would approach the manager and they felt sure she would sort it out. There have been no allegations of abuse made since the last inspection at the home and staff interviewed demonstrated some understanding of abuse of residents, but they were clearly well intentioned with the residents’ safety paramount. They have done training on abuse using a distance learning package and on their National Vocational Qualification training courses. Given that some staff are still not clear about abuse it is recommended that Abuse training be accessed from the Adult Protection Unit to make sure residents are properly protected. The resident who was interviewed said he feels safe at the home, and relatives said they had never seen or experienced anything worrying but would report any concerns to the manager. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home is well maintained but in need of redecoration to create a comfortable and homely residence. It is clean, tidy and hygienic throughout. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 20 EVIDENCE: A tour of the home was undertaken to ensure the home is safe, comfortable and well maintained. The requirements about chairs and the laundry area from the previous report have been removed, as there is no evidence from this inspection that this impacts at all on residents. There are three lounges which all interconnect on the ground floor offering residents a choice of where to sit. There is a smoker’s lounge upstairs which is appropriately ventilated. Some of the carpets need replacing and areas of the home still need redecorating. A requirement was set after the last inspection for the home to be maintained in a good state of repair and reasonably decorated. There is evidence contained in the maintenance plan to suggest that improvements are taking place throughout the home, therefore this requirement will be converted into a recommendation and progress will be checked at the next inspection to make sure the home is safe and comfortable for residents. The areas of the home seen during this inspection were clean and tidy. The last inspection by the Environmental Health Officer was positive and the kitchen was well stocked with food for the residents. The staff and relatives felt that the home needed redecoration in several areas but is well maintained, any items needing repair are usually done quickly to make sure that the residents are safe. One resident and both relatives confirmed that the home is kept clean and odour free. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. 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 the service. Staffing levels are not adequate to fully meet the high dependency needs of residents and this places them at risk of neglect by not having their assessed needs met. Staff are caring and competent but training is not delivered in a planned way which meets all statutory requirements and ensures they have all of the training they need to support residents properly. The checks undertaken on staff are not adequate and place residents at risk of harm and abuse. EVIDENCE: The staff rota was inspected along with the breakdown of levels of dependency and minimum requirements for staffing levels are met. However, it is clear from observation of the staff and residents that the staffing levels are not Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 22 sufficient to meet the residents’ care and social needs. (See comments in Standard 12). The staff interviewed felt that in the mornings they were constantly overstretched and that on many occasions they don’t know which resident to help first as so many are calling for help at the same time. This was confirmed by observations on the inspection. It is suggested that the manager and provider review the current arrangements and take action to meet the social needs of residents if the category of Dementia is to retained. A further assessment of the staffing levels and whether residents’ needs are met will be undertaken at the next inspection. Copies of certificates of training that staff have attended are held in their files, although three staff only had one or two certificates and this should be an up to date record of qualifications and training. Staff who were interviewed said that they have done National Vocational Qualification Level 2 training, Moving and Handling, Infection Control, Health and Safety and Dementia Care training. Distance learning training has also been provided on abuse. They feel they work well together as a team and are well supported by the trained staff and the manager. There is no training plan and it is recommended that the manager undertake a full training audit to make sure that all staff have had the core training necessary and develop a training plan to indicate what courses need to be provided to staff to make sure they are competent and confident in the roles they undertake. The resident and relatives said that the staff are very good, competent and caring and this view is supported by the observations from the inspection. Therefore the existing requirement for all staff to be up to date with statutory courses will be made a recommendation. Four staff files were inspected during this visit to make sure they have all of the correct documentation and information to properly protect residents from harm or abuse. Two did not have two written references, two had no date that their employment started, one had no evidence of a Protection of Vulnerable Adults First check, and one nurse’s Personal Identification Number (proof of registration as a nurse with the Nursing and Midwifery Council) had expired according to records. The last two matters were made immediate requirements to make sure that residents are properly protected from staff who may potentially abuse them. Supervision and appraisals were being conducted but not on a regular basis to make sure that staff are doing their job properly. The staff files do not meet the legal requirements and urgent action is needed to make sure that the residents are properly protected by the procedures followed at the home. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. The manager is suitably qualified and experienced to run the home. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 24 The registered providers do not check in sufficient depth about the quality of the service provided at the home and it is not therefore run in the best interests of residents. Money held on behalf of residents is stored securely and residents’ financial interests are properly protected. Health and Safety testing and servicing is not well managed and places residents at direct risk of harm. EVIDENCE: The Commission has recently approved the manager as a fit person to manage the home for Social Care Inspection. This means she satisfies the criteria and is sufficiently qualified (having achieved the Registered Manager’s Award) and with suitable training and experience to manage the home. The staff described the manager as “honest” and approachable and they feel she runs the home well. This view was also expressed by the resident and relatives interviewed. The registered providers have been undertaking monthly visits to the home and providing reports on how it is being run, and checking on the quality of the service provided to the residents. However, they have not done any quality assurance audits at the home to check more comprehensively how well the service is provided. The absence of this audit means that they cannot fully satisfy themselves that the home is being run as they would wish and in the best interests of residents. The manager sends out service user questionnaires and received 4, which had been completed on the last occasion. The main issues raised were around activities and the menu but no action/improvement plan had been formulated following the feedback. The audits should be used to inform and improve practice to benefit the residents and it is recommended that full audits of the service including the views of relatives and other professionals is undertaken a minimum of annually for this reason. Staff members and relatives confirmed that questionnaires had been used recently but they did not know the outcome. Results of feedback should be collated and given to residents or their families. The financial records for residents were inspected to make sure they are properly recorded and protect residents’ financial interests. Residents’ money which is held at the home is stored securely and good records are maintained, although it is recommended that a signature be obtained when money is given to the identified resident and receipts should be obtained when any items are bought for residents. The arrangements in place are safe and protective. Health and Safety checks and servicing records were inspected to make sure that the home is safe for residents. The fire safety testing is done at the correct intervals to make sure the safety systems will work in the event of a fire. However several checks were out of date and need doing urgently, Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 25 including the annual service for the vertical lift, tests on the water storage system to prevent Legionella and call alarm servicing to make sure that the residents can summon staff when they need to. The Portable Appliance Testing is due in November and arrangements for this test also need to be made urgently. These matters must be attended to and proof provided to ensure the safety of the residents who live at the home and protect them from hazards and harm. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 26 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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 1 34 X 35 3 36 X 37 X 38 1 Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 27 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 OP12 Regulation 16 Requirement Timescale for action 19/12/06 2. OP16 13 3. OP18 13 4. OP27 18 The registered person must consult with residents about their programme of activities and provide facilities for recreation having regards to the needs of residents. This is an outstanding requirement. The registered person must 19/11/06 ensure that residents and relatives be made aware of their right to complain and the process to follow if they have any complaints or concerns. The registered person must 19/11/06 ensure that residents are not restrained by tables placed in front of them. These must be placed to the side of the resident if not in direct use for example at mealtimes). The registered person shall, 19/12/06 having regard to the size of the home, the statement of purpose and the number and needs of the resident ensure that at all times there are adequate numbers of staff to provide for their health, welfare and meet their assessed needs. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 28 5. OP29 17, 19 6. OP29 19 7. OP38 13 The registered person must ensure that there is evidence of the professional qualifications of nurses on the premises. Immediate Requirement The registered person must ensure that there is evidence of a Protection of Vulnerable Adults First Check having been undertaken and received before new staff start work. They must work under direct supervision until the Criminal Records Bureau check is received. Immediate Requirement The registered person must ensure that the annual service on the vertical lift, Legionella checks and the call alarm servicing are undertaken as soon as possible. 21/10/06 21/10/06 19/11/06 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. 2. 3. 4. 5 6. Refer to Standard OP7 OP7 OP13 OP15 OP15 OP18 Good Practice Recommendations Care plans should be more detailed as indicated in OP7. Residents or their relatives should be involved in the development of their care plans unless there are valid, recorded reasons for this not to occur. The policy on sexuality should be more detailed and staff should be given training and support on issues of the sexuality of residents. Residents should be encouraged to sit together at a table to eat their meal and socialise. There should be a recorded menu which is displayed and available to residents and formal recording of residents’ meal choices and alternatives provided. Training on Adult Protection should be provided to staff. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 29 7. 8. 9. OP19 OP30 OP33 The registered person must ensure the home is kept in a good state of repair both internally and externally and reasonably decorated The registered person should undertake a full audit of staff training and skills to ensure statutory requirements are met and that staff are competent to undertake their role. The registered person should undertake a full quality audit on the service incorporating residents’ views a minimum of annually. These results should be collated and made available. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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. Abbeymoor Care Home DS0000059941.V313006.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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