Inspection on 20/11/08 for Abbeymoor Nursing Home

This inspection was carried out on 20th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeymoor Nursing Home 18/06/08

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Abbeymoor Nursing Home 5 Market Lane Swalwell Gateshead Tyne & Wear NE16 3DZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Irene Bowater     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Abbeymoor Nursing Home 5 Market Lane Swalwell Gateshead Tyne & Wear NE16 3DZ 01914880899 01914888202 abbeymoor@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 0 0 5 3 40 Brief description of the care home rooms. And there are small kitchenettes where 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. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit we looked at information we have received since the last visit on the 18 and 23 June 2008. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives,staff and other professionals. We checked the cost for people living in the home.Many people have their fee rates individually costed and funding comes from various sources,for example different Local Authorities and Primary Care Trusts.The nursing care element is included and this is set nationally. Care Homes for Adults (18-65 years) Page 6 of 35 Those who receive one to one care have their activities costed into the total price but items such as toiletries,clothing,newspapers and hairdressing are extra. Everyone else have the above plus activities added as an extra cost.Fee rates vary from 495 pounds to one thousand pounds per week. We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. An unannounced visit was made on the 20 November 2008.The visit took two inspectors nine hours to complete. During the visit we: Talked with people who use the service,staff,relatives and the manager. Looked at information about the people who use the service and how well their needs are being met. Looked at other records that must be kept. Checked that the 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 have been made since the last visit. We told the new manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide should be available in different ways so that people can make decisions about using the service. Care planning needs to be person centred,written in plain English and people and their Care Homes for Adults (18-65 years) Page 8 of 35 representatives need to be involved in planning and reviewing the care provided. Further work is needed to make sure people can be involved in community living and activities inside and out of the home with detailed records kept. Staff need to find out about individual preferences and lifestyles so that people can make choices and decisions about their daily and future lives. Catering staff need to be given guidance and training to give them the skills to do their job. Staff training needs to continue so that peoples complex needs can be met. All of the staff files need to be checked to see that the proper recruitment and selection guidance has been followed. The home needs to be decorated and furnished so that individual needs are met and all areas are free from potential infection. People need free access to all areas of the home and grounds without barriers and should they not be able to do this the Company needs to ensure risk assessments are in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good assessments of need are carried out before anyone is admitted,however they are not always given enough information to help them make an informed choice about moving in. Evidence: The home became part of the Huntercombe Group earlier this year.It specialises in meeting the needs of people with complex conditions such as neuro disability,acquired brain injury and spinal injuries. Although the Statement of Purpose and Service User Guide is detailed and readily available it is not in large print,picture,audio or video style. A draft document is nearly ready for review. Everyone admitted to the home has an assessment of all of their care needs,which are completed by care managers,nurse assessors and senior nursing staff.Where possible families and advocates are also involved. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: The assessment tool called Dependency Assessment Rating Tool (DART) includes areas specifically about the needs of people with a dementia related illness,behaviours that may challenge,learning disabilities and other complex health care needs. There have been no new admissions since the last visit ,however there has been some reassessment of peoples needs. Two care plans showed that health care needs were detailed but there was little information about likes,dislikes,cultural and social needs.One plan gave a very detailed,health social and personal history which gave staff clear details of how to care for this person. Another two care plans showed that details are clear and follow a person centred approach to care delivery. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in risks and choose how to make major decisions are now being adequately managed.However people are not always able to be actively involved in their chosen lifestyle. Evidence: Each person living in the home has a care plan based on the assessment before and then on admission.There have been no new admissions since the last visit to the home,however the staff have started to reassess everyones care plans. The staff are updating risk assessments for falls,moving and assisting, continence, dependency, pressure ulcer care(Waterlow) and nutrition using the Malnutrition Universal Screening Tool (MUST). Three care plans looked at have been reviewed and updated.They show that staff are starting to look at a more person centred approach to care and include likes,dislikes Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: and preferences such as prefers female carer and use none verbal signs to communicate. There was also information about food preferences such as needs pureed diet and help with meals as eats very fast.There was clear information about use of thickened fluids and making food custard consistency to prevent aspiration and choking risks. Another plan showed lots of information about diet and the persons and familys refusal to respond to advice of staff and other professionals. Staff are also starting to complete care plans for behaviours that may challenge in more detail although there is still a lot of work to do in this area.For example one person has very unsettled nights but there is no information about how this is managed or the impact it has on others. Two care plans had clear daily records about both health and social care needs.The plans had not been kept up to date and did not show how peoples needs had changed from admission. For example one person needed one to one care and was at great risk on admission.This has now lessened and the care plan does not show the improvements in this persons lifestyle. Another plan stated that one person is verbally and physically aggressive to others but this persons health has deteriorated and daily records show that this is not the case. Two of the plans show that families and care managers are involved in preparing and reviewing the care provided.Others had not been reviewed since May 2008 and one had not been updated for over a year. All of the care plans were detailed about how to use move and assist people,including details of specific hoists and slings. Daily progress notes were clear and contained details that were identified in the care plans. For example,diet,sleeping routine,continence,family and professional visits and personal care needs. The new manager and deputy manager are starting to include people in the homes daily life.Regular meetings are being arranged and staff are having training regarding supporting people to take risks and maintain independence. For example people have been consulted about mealtimes and food provision and menus are being changed.Others were consulted about activities and eight now enjoy going to college. Care Homes for Adults (18-65 years) Page 14 of 35 Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control over everyday decisions are now being adequately managed.This means people are starting to have better lifestyles. Evidence: Since the visit in June 2008 two staff have been employed to provide activities in the home. Eight people are now very enthusiastic about going to college and learning new skills. The Company have provided a mini bus so that people can either go out in small groups or on an individual basis. There is now an activity timetable which briefly records events both in and out of the home.Since the last visit people have enjoyed a Hawaiian night,Halloween and Guy Fawkes party party,one to one activities,coffee afternoons,films and a mystery Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: tour.Two trips to the pantomime have been arranged for the 4 and 5 December. Social profiles are starting but these are still in the very early stages.The information will include preferences,dislikes,previous history,goals and aspirations.They will also include any triggers that may result in any behaviours that may challenge. Staff are starting to record social events in care plans.For example trips to the Metro Centre and the local shopping centre in Blaydon. Other people have daily visits from family or go out regularly with them. Although there has been improvement in daily life staff still do not see that their actions and behaviours affect others. For example there is still some practices where people were lined up for lunch(in wheelchairs or specialist chairs)in a lounge.This meant some were unable to watch television due to others obscuring the view.Staff also are still referring to her rather than by name. In contrast other staff were very courteous and concerned to start improving the service.Staff were working with people on a one to one basis and were patient and encouraging. Physical access in around the home is limited especially when they are using wheelchairs.The upstairs unit is secured by a keypad entry system that is above wheelchair height and people have to rely on staff to let them through the doors and into the lift. Since the last visit meetings have been held and the variety,content and presentation of meals have been discussed with those living in the home. Menus are now displayed in dining rooms and offer choices for each meal. The manager has completed a survey of everyones likes and dislikes and changes to the menus are a work in progress. People also said that they would prefer protected mealtimes which means they would be able to have meals with minimum interruption from others. On arrival at the home most people were having breakfast.This included a range of cereals ,toast,preserves,bacon and eggs and a choice of drinks.All were very happy and many were enjoying a cooked breakfast although some said they just preferred cereals and toast. Hot and cold drinks were served throughout the day and given on request. Lunch is the lighter meal and consisted of hot dog roll with onions or soup and a Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: selection of sandwiches followed by Mandarin cheesecake.Other options consisted of ice cream or yogurt.Hot and cold drinks were offered throughout the meal. Moulds have been provided to make sure soft and pureed meals are nicely presented.These may have be prepared like this but some staff are still mashing food into a brown consistency which does not look appetising. People spoken to said: the meals are nice I have plenty to eat Two people said the meals are good but we no not eat vegetables as they are for rabbits. The kitchen was better stocked with tinned,frozen and some fresh and dairy products.Lots of the foods were bought in ready frozen and the manager is in the process of changing the system so that more food is prepared from raw ingredients. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to health care is satisfactory,but care planning and record keeping do not always demonstrate that everyones needs are being fully met. Evidence: Everyone living in the home has full access to a wide range of health and specialist services.These include,Huntingtons nurses,Speech and Language Therapists(SALT),psychologists,psychiatrists,continence advisers,dentists and GP practices. All of the peoples care plans are being reviewed and updated.Three showed that staff are starting to use a person centred approach to care rather than focusing on peoples health care.This means peoples abilities rather than their disabilities are being looked at and plans are starting to show how staff are supporting them. This style of care plan is still in the early stage as two other care plans still focused on peoples health care. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Information about how people are to be assisted to move around the home are very detailed with clear instructions to staff of which hoist and sling and numbers of staff needed to support individuals safely. A named nurse and key worker system has been introduced so that both staff and people living in the home can build relationships and develop a more personal approach to care. The home has comprehensive medication medication policies and procedures for staff to follow.Records are in place for all medicines,received,administered and disposed of.An audit of Controlled Drugs and Medicine Administration Records showed no discrepancies. Staff were observed giving out medication.Good hygiene practices were carried out by the nurse by hand washing and not directly handling any tablets.The nurse explained the reason for giving medication to each person and she made sure there was plenty of water available and the person took the medication. Since the last visit staff make sure all handwritten directions have two signatures and abbreviations are not used. Staff also record the room and fridge temperatures to make sure all medicines are stored safely. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding issues are now being adequately managed so that people can be protected from harm. Evidence: The Company have clear and detailed complaints and safeguarding policies and procedures for staff to use. The new manager has recorded four complaints since the visit in June 2008.They have all been investigated within timescales with action and outcomes recorded.Information about one concern was also shared with the Commission. One safeguarding alert was made in June 2008 and both the manager and the Company have worked with the Commission to put things right. Training records show that staff have completed safeguarding training with the Local Authority and in house.They have also had conflict resolution,whistle blowing and dealing with complaints training. Relatives said: Things are improving. There is still a way to go. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: There is always a response but in the past there has been no urgency. I would speak to the manager if needed. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been no change to the decor or furnishings in the last twelve months and although there is no risk further investment is needed to create a suitable and pleasant place to live. Evidence: The home was originally built and designed for older people.Now it is registered for forty younger people with complex needs. It has two separate units on each floor.It was refurbished in 2006 but has had little done since. The upstairs unit is secured by key pad and there is no free entry or exit .There are three dining rooms ,lounges and small kitchenettes as well as bathrooms toilets,and showers.There is a designated smoking room which remains sparsely furnished with the carpet covered in ash and cigarette burns.There are plans to turn this room into an office where reviews can take place in private.The smoking room will be relocated further up the corridor. The kitchenettes are now kept clean and the microwave replaced.The thresh on the door leading to the garden has been removed allowing easier access to the garden.One person did comment that this may be easier but the ramp was too steep to try on my Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: own. There are plans to redecorate the communal rooms and corridors in the near future. Many of the lounge chairs and pool table have been removed from the conservatory so that people with wheelchairs and large specialist chairs can use this area for activities. At least three of the large specialist chairs are very worn and torn and there has been some discussion about who is responsible for replacing them.If this is an assessed need the home should provide the specialist equipment. There is still some damage to bathroom walls and flooring.The back of the bath seats are still grimy and soap scummed.The flooring in the bathroom next to room 33 is grimy and cannot be easily cleaned. Staff were seen to follow infection control procedures and the home was odour free.Some bins do not have lids,the sluice disinfectors were working although the doors were not kept locked. Bedrooms are being refurbished to a nice standard.Others have plenty of personal items which reflect individual lifestyles.New profiling beds have been provided so that peoples safety can be maintained. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are now being adequately trained but further training is needed to make sure individuals lifestyles are unrestricted and they have a quality of life. Evidence: A new manager has been appointed and has been in post since September 2008.During this time there has been an active recruitment drive and new qualified nurses including a deputy manager and care staff have been employed.The manager confirmed this is an ongoing process and more staff will be recruited. Agency staff are used but the home generally has the same staff so that there is some continuity of care especially for those who require one to one care. On the day of the visit there were thirty seven people living in the home being supported by three qualified nurses, and eleven care staff.In addition there are domestics,laundry,cook,kitchen assistants,maintenance staff and a full time administrator. Two staff are currently sharing the activities full time post. Some of the staff have worked at the home for a long time and know people well.However there is still some old style practices which do not promote individualised Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: care. Staff said: Theres lots of training here and the manager has plans to bring in external trainers as well as using the internal provision. There is now a training plan which shows that staff have completed,heath and safety,whistle blowing and complaints,moving and handling,safeguarding adults,conflict and resolution,dealing with swallowing difficulties and infection control.Now the base line training has been completed specialist training is being planned for the coming year. Four staff files found that people had an application form and two references.Details regarding previous employment has not been followed up and there are no clear interview notes to discuss work history and any concerns in a persons references. References for one person were not on file and another persons disciplinary records were not available. No one can start employment without appropriate Criminal Record Bureau checks being completed. Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is showing leadership and guidance to the staff team.Shortfalls within the service have been identified and work has started to improve the quality of life for those people living in the home. Evidence: The home now has a manger who has been employed since September 2008.He is a first level registered nurse and has vast experience in the health care sector. He has gained a good understanding of the issues in the home and an action plan with timescales has been produced to show how things will be put right. The AQQA was returned to the Commission and also gave a good picture of the planned development of the home during the next year. Quality assurance systems have been reintroduced and are now being completed.These include risk monitoring for prevention of pressure ulcers and infection control.Although this has started there is still a considerable amount of work to be Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: done. Meetings with staff,relatives and people living in the home have started. People living in the home are now involved and have voted for protected mealtimes and their views on the food provision has resulted in menus being reviewed and changed. Staff meetings are held to discuss all areas that need improvement and informing them how this will be achieved.Staff also have a clearer picture about what is expected of them and most are keen to change their practices and develop the service. The manager has an open doorpolicy where relatives can come and discuss any issue they have.This is helping improve relationships with comments of: Improvements over the last month although still some way to go. A suggestion box is available where everyone can put their views about the home and service provided. The in house maintenance records are now being completed as required on a weekly and monthly basis.These include fire,water temperatures and emergency lighting. Following a health and safety meeting the thresh on the lip of the dining room door has been removed to allow easier access.And the requirements following a visit from Health and Safety Executive has resulted in a new cooker and the problems with water and boilers are being put right. All staff have now completed mandatory training. Accidents and incidents are recorded and analysis carried out to check trends. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 13 The registered persons must 27/02/2009 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 05/01/2009 ensure that all food including liquefied meals are presented in a manner, which is appealing in order to maintain appetite and nutritional status. 2 17 12,13 Care Homes for Adults (18-65 years) Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered persons must 04/05/2009 ensure that the Service User Guide is written in plain English and made available in different formats. This will make sure people understand what the home is offering so that they can make the right decision about moving in. 2 6 13 The registered persons must 31/01/2009 ensure that all care plans are brought up to date and reviewed,dated and signed on a monthly basis. This will make sure that staff know and understand peoples changing needs so that they can always receive a high quality of care. 3 17 16 The registered persons must 02/03/2009 continue to improve the variety and content of the food provision. Care Homes for Adults (18-65 years) Page 30 of 35 This will make sure everyone receives a nutritious diet which meets their individual need. 4 18 12 The registered persons must 02/03/2009 ensure that people are able to have control over personal care and all activities. This will make sure people are able to retain control and choices over their lives. 5 24 23 The registered persons must 02/03/2009 implement a planned redecoration programme for the home and refurbish or relocate the smoking room. This will make sure the home is a pleasant and safe place for people to live. 6 27 23 The registered persons must 02/02/2009 ensure that the flooring in bathroom 33 is replaced,tiles in shower room cleaned and bath chairs cleaned after each use. This will make sure that peoples privacy is maintained and the bathrooms meet peoples needs. 7 29 16 The registered persons must 02/02/2009 ensure that appropriate specialist chairs are provided to meet the needs of individuals. Care Homes for Adults (18-65 years) Page 31 of 35 This is to ensure that people have suitable specialist equipment that is clean,safe and suitable for use. 8 30 23 The registered persons must 02/03/2009 ensure all bins have suitable lids,sliuces are kept locked and all areas kept clean. This will make sure that the home remains clean and free from possible infection 9 33 18 The registered persons must 02/03/2009 ensure that there are sufficient staff on duty to care for the assessed needs of individuals. This will ensure that peoples health and social care needs are met at all times. 10 34 19 The registered persons must 30/03/2009 audit the staff records and ensure people working in the home have two references and any gaps in employment explored. This will make sure that people living in the home are protected from harm. 11 35 18 The registered persons must 08/06/2009 ensure that the staff receive specialist training. This will ensure peoples complex health and social care needs are met at all times. 12 36 18 The registered persons must 29/06/2009 ensure that staff are supervised as part of every Care Homes for Adults (18-65 years) Page 32 of 35 day practice and have formal supervison with senior staff. This will make sure that staff are supported and guided to carry out their role effectively and ensure they provide a good standard of care. 13 38 24 The registered persons must 04/05/2009 ensure that they continue to give clear direction and guidance to all grades of staff. This will ensure that the home develops an open culture which will improve peoples quality of life. 14 39 24 The registered persons must 04/05/2009 develop quality assurance and quality monitoring systems. This will ensure that peoples views will be taken into account when improving the service for those living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 7 The registered persons should ensure that care plans are detailed regarding dealing with challenging behaviours. The registered persons should make sure that people are able to make decisions about their lives and staff should record in care plans why choices and restrictions are limited or prevented. The registered persons should continue to develop social Page 33 of 35 3 14 Care Homes for Adults (18-65 years) and leisure activities according to assessed need with detailed records kept. 4 16 The registered persons should ensure that people have unrestricted access to the home and grounds unless it is subject to identified risk. The registered persons should ensure that the complaints procedure is in an appropriate style and ensure all staff listen and act on the views and concerns raised by people using the service and their relatives. The registered persons should continue to provide Safeguarding training which links into the Local Authority Procedural Framework. It is highly recommended that the manager progresses with application to become registered with the Commission. 5 22 6 23 7 37 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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