CARE HOMES FOR OLDER PEOPLE
Abbeyrose House 1 St Michaels Road Maidstone Kent ME16 8BS Lead Inspector
Maria Tucker Unannounced 2 August 2005 14:00 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Abbeyrose House Address 1 St Michaels Road Maidstone Kent ME16 8BS 01622 762369 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ramaul Ltd Mrs Heather Fe Maulayah CRH Care Home 23 Category(ies) of OP Old Age (23) registration, with number of places Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: To provide a home for two service users with dementia whose dates of birth are: 4 March 1921 and 22 April 1922 Date of last inspection 14 December 2004 Brief Description of the Service: Abbeyrose House was formerly the Vicarage of St Michaels Church, is now a residential home for people over the age of 65 years, in the town of Maidstone. The home has a large secluded and mature garden to the rear of the property.The home provides a sitting and dining area on the ground floor, with a library / quiet room which is located on the first floor. The private bedrooms are located on the first and second floors of the home but are accessible via a lift, as well as stairs. The home currently provides 15 single and 4 double bedrooms for private accommodation. The home was established in 1989, it has been under the current ownership since February 2000. Two of the responsible individuals bought out the company in 2004. The home is welcoming and well presented.The home is well located for easy access to bus services only 100 yards away and local railway approximately ½ mile away. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 15.05pm until 18.40pm. Time was spent meeting the manager and responsible individual and going through various records and documentation. About one and a half hours was spent meeting service users and a relative. A partial tour of the premises and garden was undertaken. Due to the nature of some of the service, it is difficult to reliably incorporate accurate reflections of the service users’ in the report. Some judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussions with staff and evidencing records held in the home. What the service does well: What has improved since the last inspection?
The gardens have been tidied up, with large shrubs and bushes being removed to provide a clear view of the garden. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 6 The home has built a ramp that leads to a large decking area so that service users can sit out and enjoy the garden. There continues to be a maintenance programme of renovation and renewal in the home. Some bedrooms have been redecorated; the stairs and hallways have had new carpets fitted; the front lounge has been decorated; the dinning room is in the process of being redecorated. To ensure that medication is stored and administered securely the home has purchased a new medication trolley. The formal consultation of service users in the form of meetings and questionnaires has been developed and modified i.e. documentation that it is more relevant and comprehensive. Service users meeting which focus on the services provided i.e. food. What they could do better: 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. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 6. Service users can feel confident that they will only be admitted following a full assessment of their needs and that the home are able to meet these. EVIDENCE: Service users are admitted following a full assessment undertaken by the home. Other assessments are obtained from relevant health and social care professionals as required and appropriate. Copies of these were seen to be in the service users individual files and formed part of the care plans. A relative spoken with described how the staff are competent and skilled in providing specific support stating “the staff have found a way to support and encourage …”. The manager consults the CSCI to discuss pending referrals for service users who may need specific support or those service users whose needs have changed and the home are committed to continuing to provide a service for. The home does not provide intermediate care. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8, 9,10. Service users can expect a high quality service, which promotes their health, welfare and dignity. EVIDENCE: During the inspection staff were seen and heard to be very respectful towards the service users, which was reciprocal from service users. A relative spoken with described how their relative was a very private person and the home respected this promoting their dignity and respect. Service users have their health needs promoted and maintained through medical appointments and appropriate health care professional input. The care plans have been amended to record information that may be required in the event of a hospital admission. The district nurse visits the home for health in put such as changing dressings. The owners are both qualified registered general nurses who are able to use their knowledge and experience in recognising the changing health needs of the service users and gaining the appropriate support and advice when required. The accident recordings indicated that health advice was required, this was sought and the incidents of falling resolved through a change in medication. The care plan notes contained details of specific conditions that service users had, which provided a good source of information for staff.
Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 10 The home has equipment for the promotion of tissue viability. The care plans record the service users weight to enable monitoring. The home has good systems in place for medication, which they have been improved upon for safe good practice. This includes the purchasing of a new medication trolley; photographs for identification purposes in the medication recording. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. Service users are consulted as to their preferences. They are encouraged to choose from planned activities or to relax watching the television or listening to music. EVIDENCE: The home has activities that take place in the main lounge, which the service users are encouraged to join in with. There is a separate small lounge, which is used as a quieter lounge and a small visitors room that can be used as a quiet area. The garden has a decking area and service users spoke of how they enjoyed going out there in the warmer weather. The home does provide some trips out throughout the year as well as occasional support to local based activities. The service users meeting held in June itemised a discussion on the activities and meals stating that “ mentioned …recipe book to try new meals” and “ prefers to spend time in the garden”. Also some service users would like to rest some afternoons. The home has a selection of books and activity equipment and service users rooms have their own equipment such as televisions. A service user spoken with commented that in the “morning we are busy”. A comment in a thank you card from relatives expressed how they had enjoyed attending a special birthday tea that the home had arranged to celebrate a service users birthday in the home with their family. A relative said they visit regularly and are always made welcome.
Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 12 The menu offers variety and choice. A service user spoken with had chosen an alternative meal that was their particular favourite. A relative stated that their relative had never complained about the food and appeared to enjoy it. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18. Service users can feel confident that the home are proactive in ensuring their safety and identifying and acting upon anything that may potentially be a complaint. EVIDENCE: Service users spoken with did not feel that they had any complaints. A relative said they had never had cause to complain but would feel quite happy to do so and would feel that this would be treated accordingly. The manager discussed concerns raised with a care manager in respect of a service user who managed their own finances. A relative discussed how they were appointee and provided what was requested or required. The home has not had any adult protection alerts raised and has good policies and procedures in place to protect the service users. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 24, 25, 26. Service users live in a comfortable homely environment. EVIDENCE: The home has an ongoing planned maintenance and renewal programme as part of their aspirations for providing a high level service in a well-maintained and comfortable environment. Some areas have been redecorated and new carpets fitted. It is recognised that the home is quite spacious and it will take time to totally renew and refurbish the areas that have not been done. During the inspection discussions took place as to the areas that it is considered need to be of a priority these include an area that had a slight odour and equipment such as a commode that is rusty and any soft furnishings that the home identify as being generally in need of replacing. The garden area has had a lot of work removing old shrubs and bushes to provide a better view. There is a decked area for service users to enjoy sitting outside with a gradient slope to allow safe wheel chair access. Throughout the home there are grab rails.
Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 15 The service users private rooms were individualised and personal. Some service users have bought in their own items such as a bed from home. The dinning room does not cater for all service users a fold up table could be used, if all service users chose to take meals there. The dinning room was in the process of being redecorated. There are call systems throughout the home. One service user had an individual pendant that enabled them to call for assistance. The service user stated that this was “easy, you can call staff when you want them”. The home has fail-safe devices fitted locally to prevent the risk of scalding. The laundry floor has been made permeable there was an area that is still to be done as the washing machine had been moved for access. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. Service users have a small dedicated staff team providing their services. EVIDENCE: The home has a regular staff team who provide a consistent care support team. The owner works as part of the direct care team as well as overseeing and managing the home. It was not inspected if the home has a 50 ratio of trained members of care staff with NVQ level 2 or equivalent. The staffing ratio according to the rota provided 3 care staff am and pm shifts, 2 waking night staff, a cook daily working from 7.50am to 2pm. There is a cleaner employed for 21 hours per week. To provide support at times when the manager is not on duty an on call system has been developed where senior staff and the manager are available. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 37, 38. Service users benefit from a well run and managed home that is in their best interest. EVIDENCE: The owners are both qualified general nurses who have gained considerable experience in jointly running a care home. Throughout the inspection process discussions were held in relation to the overall running of the home with documents that have been amended and systems that have been put into place for effective monitoring and seeking service users views. A recent annual audit has taken place and is in the process of being compiled to form part of the quality assurance. The responsible individual has not conducted any Regulation 26 visits. A relative spoke highly about the management of the home stating it was “run efficiently”. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 18 Throughout this and at previous inspections the owners have been open and transparent in sharing information and discussing their management and the ethos and philosophy of the home. A relative stated that they acted as appointee for their relatives funds and that the home do not hold any money. Overall the home has a good understanding into issues relating to health and safety. The accident book was filled out appropriately and recorded minor accidents. The home keeps service users personal records and daily notes within a locked cabinet. The manager amends and updates the formats for recording in line with the need of the individual service user and for the effectiveness of the homes management and running. It is recommended that the over the seat toilet frame be made secure or replaced. Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 x 3 x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x 3 x 3 2 Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 20 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 OP 33 Regulation 26 (2) (a) (3) Requirement Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by the responsible individual and shall take place at least once a month and shall be unannounced. Timescale for action To conduct visits from August 2005. 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 OP 19.1 Op 19.2 OP 19.3 Good Practice Recommendations It is recommended that the storage areas for equipment in the garden and in the home be addressed with any unwanted and unused items removed. That a review of furnishing and equipment is undertaken to identify items in need of replacing. That the ongoing renewal of the fabric and decoration continues so that the home is of a high standard throughout. It is recommended that the over the seat toilet frame be made secure or replaced. 2. OP 38.3 Abbeyrose House H56-H06 S23884 Abbeyrose V229981 020805 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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