Inspection on 18/06/08 for Abbeymoor Nursing Home

This inspection was carried out on 18th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeymoor Nursing Home 20/11/08

Abbeymoor Nursing Home 23/11/06

Abbeymoor Nursing Home 21/02/06

Abbeymoor Nursing Home 06/09/05

Abbeymoor Nursing Home 01/02/05

Abbeymoor Nursing Home 02/09/04

Abbeymoor Nursing Home 18/12/03

Abbeymoor Nursing Home 10/06/03

Abbeymoor Nursing Home 18/07/02

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Abbeymoor Nursing Home 5 Market Lane Swalwell Gateshead Tyne & Wear NE16 3DZ Lead Inspector Mrs Irene Bowater Unannounced Inspection 18 and 23rd June 2008 10:00 th Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 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 Nursing Home DS0000018165.V366866.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 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 Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeymoor Nursing Home Address 5 Market Lane Swalwell Gateshead Tyne & Wear NE16 3DZ 0191 488 0899 0191 488 8202 abbeymoor@fshc.co.uk None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Position vacant. Care Home 40 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) Category(ies) of Dementia (5), Learning disability (3), Physical registration, with number disability (40) of places Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23rd November 2006 Brief Description of the Service: Abbeymoor Nursing Home is a two-storey care home that provides care for up to forty people between the ages of eighteen to sixty five years. With complex neurological conditions. The home is of traditional brick and tile construction and it is located in a residential area, close to the Gateshead Metro Centre. It is close to the local shops, recreational facilities and transport links to both Gateshead and Newcastle upon Tyne. Access is through the car park, via a steep slope, but there is level access to the building. There are two separate units, which have communal lounges and dining rooms. And there are two small kitchenettes were people can make drinks and snacks. On the ground floor there is limited access to the garden and patio area. This floor also has a large conservatory and “games room”. The home has forty single bedrooms many with en-suite facilities. Throughout the home there are specialist bathrooms, toilets and shower facilities. The majority of people living in the home have their fee rates individually costed by the Home Manager. The funding comes from various sources, for example, different Local Authorities and Primary Care Trusts who provide the continuing care funds. The free nursing care element is included and this amount is set nationally. Those who receive one to one care have their activities costed into the total price but personal items such as toiletries, clothing newspapers, and hairdressing are extra. All other people living in the home have the above plus activities as extra cost Weekly rates vary from £496 to £1,458.41. Abbeymoor Nursing Home DS0000018165.V366866.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 0 star. This means that the people who use the service experience poor quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 23 November 2006. • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals The Visit: Unannounced visits were made on 18 and 23 June 2008. The first visit took two inspectors seven hours to complete and one inspector completed the site visit on the 23 June 2008 and this took four hours. During the visit we: • Talked with people who use the service, relatives, staff, the supervising manager and visitors. • Looked at information about the people who use the service and how well their needs are met. • Looked at a sample of other records, which must be kept. • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. • Looked around the building to make sure it was clean, safe and comfortable. • Checked what improvements had been made since the last visit We told the supervising manager what we found and arranged to meet the Regional Manager to discuss our concerns about the service. We alerted the Local Authority Safeguarding team about incidents that may have happened to people living in the home. What the service does well: The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 6 There are links with other health professionals on a regular basis. Staff make sure people receive their medication at the right time. They make sure that all checks and clearances are received before staff are employed. There are good arrangements for supporting people to keep their personal monies in a safe place if they want. What has improved since the last inspection? What they could do better: The home must have an effective manager to improve the standards and to make sure that there is effective leadership in the day-to-day management of the home. This will also improve the standard of the care being given and support people to have a good quality of life taking into account their views and choices. The staff must be supported so that they can feel confident that they will be able to meet people’s needs in a professional manner, taking the principles of a person centred approach to care into account The Service User Guide and Statement of Purpose should be available in different ways to help people make a decision about using the service. Further work is needed with care planning so that they clearly detail the wishes of people using the service, and the care and support needed to meet people’s needs. People and their representatives need to be involved in planning their own care with staff. Information about peoples lifestyles and choices before they moved in need to be written down so that staff can continue to support them or, help them access help from others. Where information about changes to medicine have been recorded this must be signed for by the person administering the medicine and witnessed by a second person. Abbreviations must not be used. This will make sure medicines are given safely. The temperature in the treatment room must be recorded so that all medicines can be kept at the proper temperature. The home must make sure that people can be involved with a variety of activities both on an individual and group basis. A record of all activities must be recorded. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 7 Staff must make sure that people’s rights to dignity and privacy are respected at all times. People must also be given the right to make choices about all aspects of their lives. These details must be recorded in the care plan and then followed by all staff. The menus and food provision need to be looked at again and so that people can have a choice of food that is nicely cooked and presented. There must be a good control of food supplies so that there is always sufficient food in the home. And food that is out of date discarded. The catering team need to have more training to give them the skills to do their job. Care staff also need to have food hygiene training. All concerns and complaints need to be listened to and all actions and outcomes must be clearly recorded. All specialist, safeguarding adults and mandatory training needs to be brought up to date. And, staff need to follow Local Authority guidance should there be any allegation or suspicion of abuse. The staffing levels, training and skills of the staff team need to be reviewed so that the staff are confident they have the skills to do the job. There needs to be a good recruitment and selection programme for new staff so that the core staff are not working excessive hours. All areas of the home need to be nicely decorated and free from potential infection. All maintenance checks must be completed as Company policy. Staff must always have fire training three monthly and six monthly with detailed records kept. All records must be available, clear up to date and kept in accordance with the Data Protection Act. People need to be free to access the home and grounds without barriers and where they are not able to do this, the company needs to explore why they can’t and take action to address this. CSCI must be told in writing when the service has any serious concerns either about people using the service or anything affecting the service. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 8 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. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although good assessments of need are made before moving into the home, people are not given enough information to help them make an informed choice about moving in EVIDENCE: The Company is still part of Four Seasons Healthcare (England) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) but the home recently became part of the Huntercombe Group, which specialises in meeting the needs of people with complex conditions such as, neuro disability, acquired brain injury and spinal injury. The statement of purpose and service user guide is readily available in the reception area of the home. Although the information provided is detailed it is not available in other formats such as, picture or large print style to help people understand the information. No video or audio explanation is available either where people may not be able to read information as a result of their brain injury. Everyone admitted to the home has an assessment of all care needs, which is completed by care managers, nurse assessors and senior nursing staff. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 11 The Company have a Dependency Assessment Rating Tool (DART) assessment document that includes areas specifically about the needs of people who have dementia, challenging behaviours, learning disabilities, physical disability and other complex health care needs. Four care plans showed that these were completed in detail and information from other professionals is sought so that the staff can start to complete care plans based on individual needs and wishes. Staff had asked for a care manager’s assessment for one person but this had not been given. The assessments were very clear about health care needs but did not show how people would be supported to maintain social, educational, and cultural or faith needs. Those who have a one to one, which is funded, did not have a care assessment about any social care needs or individual interests. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Opportunities to take part in life risks and choose how to make major decisions are poorly managed. This prevents people from being actively involved in their chosen lifestyle. EVIDENCE: Each person has a care plan that is based on the information given before and on admission to the home. The Company have detailed assessments for staff to use. These include pressure sore risk, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. One person was described as “a fussy eater”, refuses several foods or demands food not available”. But there was no detail about food preferences or, why or what is refused by the person. There was no care plan available Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 13 about this persons social care needs. This person has funding for one to one care and the service clearly are not able to demonstrate how this is supported. While a care plan about behaviours that challenge the service is in place for one person it does not show how staff can support this person when anxious or distressed. And it fails to show staff how to identify things that might trigger the behaviour and therefore, help them develop strategies to prevent or distract the behaviour, or diffuse the situation as recommended by the British Institute of Learning Disabilities (BILD). For example, “can be verbally aggressive”, gives very little detail and does not explain what the behaviour is or how it impacts on the person’s quality of life. Three care plans were detailed and showed contact with other professionals but had not been updated since April 2008. Also staff had not signed nor dated their entries. For example staff make sure specialist reviews take place and details about one persons fluid intake and daily weights are clear. People living in the home are not consulted about life in the home. They are not involved in meetings or are supported to take risks and have any independence. One person said that routines, such as showering are led by staff, not by service user’s choice. People using the service said: “Nothing happens,” “You don’t get out, you go out once a week to the shops if you are lucky.” “Every day’s the same.” “The Royal Ascot day’s the first thing since Christmas.” Access in and around the home is restricted for people who use wheelchairs, particularly those people who live on the first floor unit by difficulties in layout and design of the building. Risk assessments are not undertaken to show why people are unable to access other parts of the home and grounds. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited, and content and organisation of mealtimes poorly organised. This prevents people from leading full and active lives. EVIDENCE: There is a vacancy for a fulltime designated activities person which continues to be advertised. Staff usually plan events when their main duties have been completed. Since the last visit in 2006 there has been a decline in events, which happen both inside, and out of the home. No one goes to day centres or colleges and no one has anyone been on holiday. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 15 There is little information available to show that people are being supported to take up any preferred activity or join any local clubs. Information about local events happening in Gateshead and Newcastle are not available and there is currently no access to any specialist organisations. The home has applied to have a mini bus so that people can get out and about. In reality access to transport and outings on either a group or individual basis is limited. Events have been arranged in the home but these do not take place on a regular basis. There is a file with information about enjoying themed events such as a ‘Welsh’ event and St Georges day event. There was also information about painting, ceramic painting and a demonstration of how to make a trifle. On the first visit there was little going on both units. In the afternoon some were being helped to make hats for “Ascot Day” on the Friday. On the second visit people were playing cards with the staff and others were chatting or watching television. None of these activities are recorded anywhere. Comments from people using the service included: “You don’t get out, you go out once a week to the shop if you are lucky,” “Everyday is the same,” “I spend most of my time in my room watching television,” “There’s nothing going on,” “We don’t go out they (the staff) are too busy,” “The rules vary from day to day.” Visitors and families are welcomed at any time and there is no restriction on where they meet. There has been shortages of staff for some time This has resulted in staff being unable to provide a person centred approach and people using the service have had less opportunity to mix with the wider community and lead meaningful or fulfilling lifestyles. While some elements of privacy and dignity are promoted by using people’s preferred name and knocking on doors before going into a bedroom, there were other practices which were degrading and compromised people’s dignity. For example, a person being hoisted was distressed by the experience and screamed, staff shouted out for all to hear, “ it’s ok they don’t like being hoisted”, and when a person asked for a drink a member of staff said, “ you’ve already had yours at half past ten.” Another person was taken away by a member of staff and asked where they were going, the staff member didn’t tell the person they were going to have their blood levels checked and only said, Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 16 “you’ll be back before dinner.” Other comments made by some staff have become the subject of a safeguarding adults alert to the local authority. Physical access in and around the home is limited for people with varying degrees of mobility difficulties, especially where people may rely on wheelchairs to get around. The upstairs ‘unit’ is secured by a keypad entry system that is above the height, which would be easy for them to access, and so people rely on staff to let them through doors where they are sited. Concerns were raised by both relatives and people living in the home about the variety and quality of the meals. There is no provision on a daily basis for anyone to have a cooked breakfast. Everyone said they always just had cereal and toast .The staff said that a cooked breakfast was available on request and on a Saturday they could have a cooked breakfast “as a special treat”. Staff said no one could have bacon sandwiches or any other variety with bacon it is not on the menu because of the cost. Comments from relatives and people using the service backed this up: “You never smell bacon” and, “You don’t get a cooked breakfast”. One person asked what was for dinner and staff answered, “I don’t know”. The lunchtime meal is the light meal of the day with the main meal being served at teatime. And lunch consisted of pie and beans with bread and butter or a selection of sandwiches with oxtail soup. For dessert there were scones, yoghurts or fruit. Drinks were available throughout the meal. The meals are prepared in the main kitchen, plated and then served from a “hot lock”. When meals are served in this way it doesn’t prompt choice or encourage people to maintain any independent skills they may have and become reliant on staff. Some people have to have their meals softened or liquidised as they have swallowing difficulties and are at risk of choking. But the meal was blended pie mashed potatoes and gravy and looked like brown ‘mush’ on the plate. Concerns have also been raised that sometimes the food has not been blended enough and sometimes still has gristle and solid lumps in the mixture. This could be a choking risk for people who have difficulties swallowing. One person asked for and was given another slice of bread and butter and made bean sandwiches. When asked if he was still hungry said “I am always hungry”. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 17 Drinks were offered at mid morning and afternoon. Should anyone wish a drink in between these times it was not readily available. But one person said “no cup of tea yet” and was told “you’ve already had yours at half past ten”. One person said, “two packets of crisps were offered” when the meal was not wanted. Another person said, “the food is appalling”. The kitchen had very limited supplies of food, but the order was due in that afternoon. However, when supplies arrived they only consisted of adequate amounts of food and there was not a lot of fresh food in the fridges such as cold, cooked meats, cheeses, yoghurts, salad items, fruit juices, fresh cream, sausages, bacon and snack items. Menus are not displayed or show what actually is available and again this limits people’s abilities to make decisions and choices over everyday matters. The menus have not been changed since the main meal was changed to the evening. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Access to health care is satisfactory, but lack of detailed care planning and ability to make choices does not demonstrate that people’s needs are being fully met. EVIDENCE: People living in the home have wide access to all NHS and specialist services. These include specialist nurses, psychiatrists, occupational and speech therapists. There is also consultation with the Primary Care Trusts throughout the region. While care plans show details of people’s personal health care they are based on a medical model of care and lack a person centred approach. This type of approach places the focus of care on the person’s disability as being the ‘problem’ rather than the social model which looks at the barriers faced by the person with a disability and therefore, looks at a whole range of needs/wishes of the person to be supported. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 19 While some social care plans are in place they lack the level of detail that would show that people have been consulted and helped to draw up the plan and keep control over decision making (where able to) about their everyday lives. Staff don’t record activities that have taken place or whether people have enjoyed an activity, which could provide useful information about future activities. The home does not have a “key worker” system in place so that no one can be sure who will be supporting them on any day. Comments from staff indicate that people are not really given choices about baths, showers and meal times. “One side gets showered one day and the other side the next day” One person said they would prefer a shower every day but “that never happens”. Mealtimes happen at the same time and there are limited activities especially in the evening given the night staff start duty at seven thirty pm. The home has comprehensive medication policies and procedures for staff to use. Records are in place for all medicines received, administered and disposed of. And an audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. However, when staff are handwriting changes to directions (from the GP) on the M.A.R. sheets there are not two witness signatures. Also staff are using medical abbreviations such as B.D and T.D.S. This information must be written in full to show that the correct directions have been carried out and would reduce the possibility of error. The treatment room was also very warm and the daily temperature is not recorded to show that 25C is not exceeded. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints and safeguarding issues are not well managed and leave people at risk of harm. EVIDENCE: The visit to the home was triggered by complaints made to the Commission about various incidents that had happened in the home. These had allegedly also been discussed at home level and care managers had also been told. Both relatives and people who use the service discussed various incidents that had happened. The Commission informed the Safeguarding team about the issues found during the site visits. The Local Authority is now dealing these with. The supervising manager was informed of one serious incident and she took immediate steps to make sure people were kept safe. Following the allegations the supervising manager took appropriate action to make sure people living in the home remained safe. People living in the home complained that staff restricting smoking, times of showers, choice of food and when they can go out. They also said “the rules vary from day to day” and “ they never got any response if they did complain.” Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 21 Relatives also said that although they have raised concerns about their relative They said that these issues have been going on for some time but they don’t an adequate response and little has changed. The Company has very detailed and clear policies and procedures about how to make a complaint and how to make sure people are protected from harm. The only complaints book available was a small red book. Inside three pages had been torn out and the last record was July 2007. Given the numerous complaints given during the site visits it is evident that all concerns are not viewed as serious and nothing has been done to put things right. Staff do not see that their attitude and behaviours could be seen as institutional care practice although attempts to change systems are being put in place. The have been no previous safeguarding alerts in the home. The supervising manager later confirmed that Safeguarding training had been organised as a priority. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a comfortable place to live but it is only adequately maintained and it does not always encourage people to be independent. EVIDENCE: The home was originally built and designed for older people. It is now registered for forty younger people with various complex needs. It has two separate twenty bedded units. The home had a refurbishment in 2006 but little has been done since. The unit upstairs is secured by a keypad entry system and people living on this unit have no free entry or exit from this floor or the building as a whole. There are two dining areas, lounges and small kitchenettes as well as bedrooms bathrooms, showers and toilets. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 23 There is a designated smoking room for people to use. There was a strong smell of cigarettes despite the extractor being on. The room was sparsely furnished and the carpet covered with ash and cigarette burn marks. The small dining room walls were damaged and food was splattered. The fire door release mechanism was broken with the door in the open position. The small kitchenette off the larger lounge was not clean. The drawers were stained with coffee or tea spillage. The drawers were not attached to the runners and a named persons “Thick and Easy was left out on the work top. In the other kitchenette the fridge was filthy inside and out with various items of food being out of date. A requirement was made to throw out this food at once. The microwave had food splattered inside and the lining was starting to come away from the top. The downstairs unit is accessed from the main entrance and this is also key padded for both entry and exit. This unit has a very large dining room leading to a garden area. Access to wheelchair users is limited due to the high threshold “lip” on the door, which makes it difficult for a wheelchair user to negotiate. One person said she would not “chance” going out independently as “it was to hard to manoeuvre” and the slope into the garden “too steep” for the wheelchair. This unit has a plenty of communal space and includes, a lounge, large conservatory and games room. Bedrooms, bathrooms, shower and toilets are also on this unit. Some of these would be difficult to access for those with mobility difficulties. The only room in use was the one lounge were everyone sat during the day. There is also another patio area at the end of the corridor, which was easier to access. When asked why this was not being used as it was a pleasant summer day the answer was “its just for the smokers”. All of the walls on both units are marked and damaged from wheelchairs and trolleys. The radiator in the downstairs dining room was loose and a pair of wheelchair footrests had been left on the floor. All of the walls on both units are marked and damaged from wheelchairs and trolleys. Bathrooms and shower rooms are clinical and some personal toiletries had been left unattended. Underneath of shower chairs were grimy and weren’t Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 24 properly cleaned. One bathroom is used as a storage room and contained five black bags full of personal clothing, six wheelchairs and a hoist. Sluices were not locked although the sluice disinfectors worked. The open hopper was grimy and smelly. Bins did not have lids and all of the extractor fans need cleaning. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels and systems around recruitment, selection and training of staff are inadequate to meet the range of needs of the people using the service. This means that people’s lifestyles are restricted and overall affects their quality of life. EVIDENCE: The home currently does not have a registered manager. A manager from another service comes to the home about twice a week to address any immediate concerns. The regional manager visits the home on a regular basis. There are forty people living on two separate locked units. During the day there are three nurses and nine care staff on duty. Overnight there are two nurses and four care staff on duty. Staff work twelve-hour shifts from seven thirty am to seven thirty pm when the night staff come on duty. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 26 There is also an administrator, two laundry and three domestic staff. There is one vacancy for a domestic. In addition there are two cooks ,two kitchen assistants and a maintenance person. The home also has a vacancy for a fulltime activities co-ordinator. Although some of the staff have worked at the home for some considerable time the rota shows that staff have left have been off sick or absent from duty. This means other staff have worked excess hours, which may result in them becoming tired and unable to carry out their duties effectively. The home no longer works a “key worker” system and people using the service do not have allocated staff to support them. Those who are funded for one to one care do not always have care staff that can understand their likes, dislikes and specialist needs. There were complaints about lack of staff from people who use the service and from relatives. They were also concerned that staff were not being supervised, sleeping on duty and use of mobile phones. Other comments included: “We have to wait until they are ready to help” “Cigarettes are locked away and smoking is only allowed at certain times” “The rules vary from day to day” Some of the staff have worked at the home for a long time and know people well. However at the time of the visits there were generally no meaningful activities taking place. People on the downstairs unit were generally sat in one lounge with the television on. Upstairs some sat in lounges or in their own rooms. The main focus of the day was to make sure people’s personal care needs were met. There was little in the way of individualised care provision. A comment from staff was: “One side is showered on day and the next day the other side is showered”. Given the complex needs of the people living in the home specialist training has not been kept up to date. All staff have recently completed Control and restraint training and there are plans in place so that staff can complete safeguarding, person centred care and care plan training. The staff confirmed that they had little in the way of specialist training. One member of staff was very knowledgeable about providing a “person centred approach” to care delivery and how risks should be managed so that people can live independent lives as far as possible. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 27 The records for recruitment were satisfactory. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, two written references, proof of identity and professional identity numbers for registered nurses. Information was available to show that senior staff are aware of the staffing issues in the home. A recruitment day was planned for the Friday after the site visit. On the return visit fourteen application forms had been sent out. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42.Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of leadership and management has placed people who use the service at risk of harm. EVIDENCE: The registered manager has been off for some time and is leaving. This means There has been a lack of leadership and supervision in the home. Staff have had little direction and supervision and have been unsure what is expected of them and then doing what they think is right. This means the focus has been the task, getting the job done without looking at the individual needs of those using the service. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 29 Although the Company has detailed quality assurance and quality monitoring systems in place these have not been completed for some time. The Huntercombe Group of Four Seasons Healthcare have recently taken over the overall management of the service. While there is manager providing some oversight until a suitable manager is employed she has insufficient time to effectively oversee and manage all aspects of the service Between the Regional Manager and the overseeing manager an action plan is being implemented to show how they intend to put things right. The plan is to include up to date training in safe working practices and specialist training for staff. People using the service and their relatives were not confident that their views are listened to or valued. There is little evidence that regular meetings have been held for some time. Many of the records were not available up to date or in good order. Maintenance records were not up to date. Checks had last been recorded in May 2008. Accidents are recorded but monthly analysis is not carried out to track to examine and track any trends. No one could be sure if the incidents and accidents, which affect people living in the home, had been reported to the Commission. An immediate requirement notice was given, as staff had received no fire training or instruction since 9 October 2007.There was a broken fire release mechanism on the small dining room door upstairs and out of date food was being stored in the upstairs kitchenette. It was confirmed that these problems were being put right. There is water damage to the ceiling in the kitchen and the paint is peeling. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 1 32 X 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 1 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 1 1 1 X X 2 X Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 4 Requirement The registered persons must ensure that the Service User Guide is written in plain English and made available in a language and format suitable for people to use and understand The registered persons must ensure that the care plans are reviewed at least monthly, are person centred and reflect how current and changing needs will be met. This must include how to deal with behaviours that challenge The registered persons must ensure that people are able to make decisions about their lives and record in the care plan reasons why choices and decisions are limited or prevented. The registered persons must ensure that people living in the home are consulted on and participate in all aspects of life in the home. The registered persons must ensure that people living in the home are given sufficient DS0000018165.V366866.R01.S.doc Timescale for action 01/10/08 2 YA6 13,15 01/09/08 3 YA7 13 01/09/08 4 YA8 24 01/09/08 5 YA9 13 01/09/08 Abbeymoor Nursing Home Version 5.2 Page 32 6 YA13 16 7 YA14 12,14,16 8 YA16 12,16 9 YA17 16 10 YA17 12,13 11 YA17 12 12 YA18 12 information about their safety and risk management strategies put in place, which are recorded and reviewed in the care plan. The registered persons must ensure that people living in the home are supported to become part of the local community according to assessed need. The registered persons must ensure that a planned range of social activities is available. People must be given opportunities to be involved in varied and individualised social activities, which must be recorded in detail. The registered persons must ensure that staff respect people’s rights and choices and access to the home and grounds is unrestricted unless it subject to identified and recorded risk. The registered persons must ensure that everyone living in the home receives a varied appealing nutritious diet, which is suited to individual assessed and recorded requirements. The registered persons must ensure that all food including liquefied meals are presented in a manner, which is appealing in order to maintain appetite and nutritional status. The registered persons must ensure that there is a menu that offers choice of all meals, which is written in a style understood by the people living in the home. The registered persons must ensure that people living in DS0000018165.V366866.R01.S.doc 01/09/08 01/09/08 01/09/08 01/08/08 01/08/08 01/08/08 01/09/08 Abbeymoor Nursing Home Version 5.2 Page 33 13 YA20 12,13 14 YA22 22 15 YA23 12,13 16 YA23 12,13 17 YA24 13,23 18 YA27 12,12,23 the home are able to have control over their personal care, bed times and other activities including evenings and weekends. The registered persons must ensure that all hand written directions on the medicine administration records have two witness signatures and staff must not use abbreviations. The room temperature must be recorded to ensure 25C is not exceeded The registered persons must ensure that a record of all concerns and complaints are kept with details of investigation and any other action taken The registered persons must ensure that senior staff completes the Alerter Training, which is facilitated by the Local Authority. Staff must refer any safeguarding issues to the Local Authority and the Commission. The registered persons must ensure that all staff understand the safeguarding and whistle blowing procedures The registered persons must ensure that all areas of the home are kept in a good state of decoration. All areas of the home must be accessible to those using wheel chairs. The carpet in the smoking room must be replaced and kitchenettes kept clean. The registered persons must ensure personal toiletries are not left unattended. Underneath of shower chairs must be cleaned on a regular DS0000018165.V366866.R01.S.doc 01/08/08 01/08/08 01/09/08 01/08/08 01/09/08 01/09/08 Abbeymoor Nursing Home Version 5.2 Page 34 19 YA30 20 YA31 21 YA33 22 YA35 23 24 YA37 YA38 25 YA39 26 YA42 basis. The bathroom used as a storage room must be cleared of clutter and returned to its original use. 13,23 The registered persons must ensure that sluices are kept locked, all bins must have appropriate lids, and the open sluice hopper must be cleaned regularly to stop odours. 1318 The registered persons must ensure that all staff understand what their roles and responsibilities are. 18 The registered persons must ensure that there are sufficient numbers of staff on duty at all times to care for the assessed needs of the people living in the home. 12,18 The registered persons must develop a training programme so that all grades of staff have the skill and knowledge to support people with complex health and social care needs. 9, The registered persons must continue the recruitment process for a manager 5,10,12,21,24 The registered persons must ensure that there is clear communication and a sense of direction given to staff when there is no manager in post. 24 The registered persons must maintain systems of evaluating all aspects of the service and take the views of people using the service into account 12,13,23 The registered persons must ensure that fire drills and fire training is kept up to date with records kept. All in house maintenance records must be kept up to 01/09/08 01/09/08 01/08/08 01/09/08 01/10/08 01/08/08 01/10/08 01/08/08 Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 35 date. All food must be stored according to legislation and all areas be kept clean. Accident and incident analysis must be carried out and any incident that affects the well being of anyone living in the home must be reported to the Commission. The kitchen ceiling must be repaired. 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 YA29 Good Practice Recommendations The registered persons should consider providing automatic doors to enable people to access the home. Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Abbeymoor Nursing Home DS0000018165.V366866.R01.S.doc Version 5.2 Page 37 - 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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