Inspection on 13/09/07 for Abbeyrose Nursing Home

This inspection was carried out on 13th September 2007.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbeyrose Nursing Home 07/07/08

Abbeyrose Nursing Home 22/01/08

Abbeyrose Nursing Home 29/08/06

Abbeyrose Nursing Home 22/11/05

Abbeyrose Nursing Home 19/05/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Abbeyrose Nursing Home 38 Orchard Road Erdington Birmingham West Midlands B24 9JA Lead Inspector Ann Farrell Key Unannounced Inspection 13th September 2007 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyrose Nursing Home Address 38 Orchard Road Erdington Birmingham West Midlands B24 9JA 0121 377 6707 0121 240 6181 enquiries@abbeyrose.org.uk 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) MACC Care Limited Steven Keneth January Kazembe Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the Home is registered for nursing care for a maximum of 30 service users for reasons of old age (OP). That the home can continue to provide care for existing named service users for reasons of Physical Disability (PD) - 1 person and Mental Disorder (MD) - 2 people. 29th August 2006 Date of last inspection Brief Description of the Service: Abbeyrose is a three storey detached property situated in a quiet residential area in Erdington. It is approximately half a mile from the main shopping area and is within close proximity of public transport. There is limited parking to the front of the property with a large pleasant enclosed garden to the rear. The ground floor and first floor provide accommodation for thirty residents over 65 years of age who require nursing care. The third floor of the property is designed for staff use only. The home has twenty-four single bedrooms and three double bedrooms. All rooms have a wash hand basin and seven of the single bedrooms have en-suite facilities. Double rooms are provided with privacy curtains. There are four bathing facilities divided between the two floors, which provide a choice of bathing facility. A range of equipment is available for moving and handling residents plus raised toilet seat and handrails for those with mobility problems. A passenger lift is available that gives access to the first floor. The kitchen is situated on the ground floor and the laundry is separate to the main building at the rear of the garden. There is one combined lounge dining room to the front of the property with a pleasant conservatory to the rear, which looks out on to the garden. In addition, there are two further small sitting rooms providing a choice of areas for residents to sit. Information is available to prospective residents and their representatives in the form of a service user guide. The information indicated that fees range from £383 to £805 per week depending on accommodation and dependency. This includes the fee paid by the Primary Care Trust in respect of the nursing element. Fees do not include services such as hairdresser, chiropody, taxi fares, toiletries etc. and they are reviewed annually Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social care inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development The inspection was conducted over three days commencing at 12.00pm and the home/provider did not know we were coming. This was the first statutory key inspection for 2007/2008 and the manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection; on the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home plus conversation with managerial and care staff plus visitors and some residents. A number of residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Written and verbal comments were also received from relatives and health professionals and the responses were varied with both positive and negative comments. What the service does well: What has improved since the last inspection? Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 6 There is an ongoing re-decoration and re-furbishment programme, which is in place and a number of bedrooms and corridors had been decorated, new carpets and furniture provided, so enhancing the environment for residents. Birthdays and special events such as Christmas, Easter etc. are celebrated, so enhancing the quality of resident’s life. A review was undertaken by the tissue viability service and new mattress have been provided, so reducing the risk of pressure sores to residents at risk. A system of obtaining regular feedback from relatives has been implemented through questionnaires to assist with improving quality in the home. Feedback from relatives indicated they appreciated this process. Progressive mobility visit on a regular basis providing a range of exercises, so maintaining some residents mobility What they could do better: There needs to be a more pro-active approach to care with monitoring, early identification of concerns and appropriate referral to health professionals to ensure residents health care needs are met. The systems for dealing with concerns and complaints need to be more robust. All concerns/complaints recorded, investigated and acted upon to ensure residents are adequately protected and learning is achieved to lead to continued improvements. The assessment and care planning process needs to be enhanced to ensure resident’s needs are identified and consistently met by staff who are familiar with the agreed plan of care. There needs to be more attention to detail in meeting residents personal and nursing care needs whilst respecting their privacy and taking their wishes into consideration. The arrangements for activities needs to be developed further both in the home and outside to ensure residents are adequately stimulated. Further staff training is required to ensure staff have the appropriate skills and knowledge to care for residents effectively and in a consistent manner. The shortfalls in respect of team working, staff attitude and communication needs to be addressed to ensure resident’s needs are met and outcomes are positive by a fully committed and positive staff group. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 7 Formal staff supervision need to be implemented to ensure staff receive appropriate support/guidance and training both inside the home as well as from external training courses. The quality assurance system needs to be developed further with feedback from residents and other stakeholders plus audits to identify areas that need improvement and development plans drawn up indicating outcomes for residents. The seating and dining arrangements in the home should be reviewed and action taken to provide a more social environment that allows interaction and stimulation of residents. A review of staffing levels and skill mix should be undertaken and action taken to ensure there are adequately trained staff in appropriate numbers at all times to meet residents needs. 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. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information was available to enable residents or relatives to make a choice about whether the home is suitable for their needs. The collection of information about residents needs before they move into the home was adequate to enable staff to determine if they could meet resident’s basic needs on admission to the home. EVIDENCE: The home provides long term nursing care for residents over 65 years of age. Information was available for prospective residents and their families in the form of a service user guide and copies were available in each resident’s bedroom. The document included information about the services and facilities plus a contract of residence enabling residents and their representative to make an informed decision about moving into the home. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 10 A contract of residence was used for privately funded residents. However, a contract or terms and conditions will need to be provided to residents funded by Social Care and Health also to ensure they are aware of the terms of residency. The manager undertakes a pre-admission assessment for all residents wishing to move into the home. Prospective residents are also able to visit the home enabling them to view facilities and meet staff etc. so they can make a decision about moving in. On inspection of a sample of records it was noted that a preadmission document had been completed in all cases and provided basic information enabling the person to decide if the home could meet their needs. They also write to confirm if they are able to meet prospective residents needs, so providing confidence to the person that their needs will be met following admission. The home has a number of residents who suffer with confusion or dementia. Previous inspections have identified that training was required in this area in order to provide staff with the knowledge and skills to care for residents and this still needs to be addressed. The home is not registered to care to admit residents who are diagnosed with dementia. If they wish to change this they will need to apply to the Commission and demonstrate that they can meet these residents needs. Some of the rooms are small, toilets, en-suite and assisted bathing facilities have limited space and it would be difficult to manoeuvre equipment such as hoists for manual handling. The manager of the home must ensure that when assessing residents for admission to the home these factors are taken into consideration and ensure residents needs can be met by the facilities available. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning need developing to ensure all residents’ needs are identified and met in a consistent and appropriate manner. Residents health care needs are not consistently met in an effective manner and there needs to be a more proactive approach to care and follow up to ensure residents well being is maintained. Although there had been some improvements in the medication system since the last inspection there were still a number of shortfalls so residents are not consistently receiving the correct dose of medication prescribed by health professionals. EVIDENCE: Following admission to the home a nursing assessment and risk assessments are completed in order to provide adequate information to draw up a care plan. In some cases staff also have information in the form of a care plan form Social Services. On inspection it was found that the information on the assessment differed to that provided by the Social Worker. Also the nursing assessment contained the basic information that had been recorded in the pre Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 12 admission assessment and a number of areas had not been addressed. There was no evidence of a continence assessment where residents experienced problems and the mental health assessment was vague with comments such as mixed moods. Also there was no evidence that the residents or their representative had been involved in the process. Risk assessments had been completed in respect of moving and handling, skin integrity, falls, nutrition etc. Some of the information provided in the risk assessments was vague and there was no care plan to support them in some cases e.g. manual handling. The care plans were based on the assessment and it was found that they contained vague statements e.g. monitor weight, check regularly, change incontinent pads promptly, provide and use pressure relieving equipment encourage adequate fluid intake. In some cases risk had been identified, but there was no plan of care in place indicating how the risk should be reduced e.g. choking. There were a number of inconsistencies in the records e.g. an assessment stated that a resident could not walk, other records stated they could weight bear and the daily record stated they were mobilising with one member of staff. Some care plans indicated that resident’s food and fluid intake should be monitored or they should have pressure relieved regularly to prevent the risk of pressure sores. On inspection of fluid and food charts it was noted that a number of residents were not receiving an adequate food or fluid intake and they had not been turned regularly or pressure relieved. In one case it was noted that a nurse had written the daily record indicating that a resident was taking fluids well yet the chart indicated that on some days they had drank half a litre of fluid which is not adequate. The record of food intake stated puree meal, but there was no indication of the amount of food eaten. Where such areas are monitored accurate recordings should be completed and where there are any inadequacies action should be taken. The daily recording was very generalised, were based on tasks, did not reflect care provided or changes in resident’s conditions/moods etc. so that it could be determined how the residents was progressing. This area will need to be addressed to demonstrate resident’s needs are met. On discussion with some staff about care plans they did not have knowledge of them and had very little knowledge about residents needs. Feedback was received by the Commission that also confirmed this, as it was stated staff were not aware of residents likes and dislikes etc. Resident’s nutritional status was monitored through regular weighing and nutritional screening. Staff do not use an objective tool such as body mass index to determine if residents are receiving adequate nutrition. It was noted that some residents were of low weight and others had lost weight, but there was no evidence in the records that action had been taken consistently to Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 13 address the issue or that food boosters were in use to improve nutritional status. A number of residents were prescribed nutritional supplements due to nutritional intake. It was noted that nurses had signed to say that they had been administered, but on checking residents fluid charts it was found the residents had not had them. All residents body mass index should be assessed and appropriate action taken where it is below 20. Records indicated that residents were washed each day by staff but there was no evidence that they had opportunity for a shower of bath. On discussion with a resident they indicated that the quality of the wash provided was not of an adequate standard. In another case it was noted that a resident had an excessive amount of talcum powder on their body, which can cause drying of the skin and increase the risk of tissue damage. Also some residents whose fluid intake was poor were found to have dry mouths and there was no evidence of equipment for oral care. In some cases where residents were assisted by staff with personal care and getting up it was found that oral care or teeth had not been attended to. Some resident’s nails were not cleaned adequately and hair was poorly managed in some cases. Whilst touring the home it was noted that bed safety rails were in place in a number of areas. In some cases there was a gap between the bed rail and the mattress and where beds were positioned against the wall there was only bed rail in position, some did not have bumpers in place and so puts residents at risk of injury. In some cases there was pressure-relieving equipment on beds and the height of the bed rail was reduced. A review of all bed rails should be undertaken to ensure they are safe and fit for use. A system of checking bed rails on a regular basis should also be implemented. Care plans stated that some residents required sliding sheets for safe movement when in bed. However, on inspection of some resident’s rooms who were nursed in bed there was no evidence of any slide sheets. At the tiem of inspection the manager stated that they were in the laundry. A review should be undertaken and action taken to ensure all residents who require a slide sheet have one for their own use at all times to reduce the risk of cross infection. Since the last inspection a tissue viability audit had been undertaken by the tissue viability service, who made recommendations. Following the audit a number of new pressure reduction and pressure relieving mattress have been purchased to reduce the risk of residents developing pressure who are at risk. In, addition a further four profiling beds have been purchased and are used to aid positioning and turning of residents who spend long periods of time in bed. A range of new chairs has been purchased for the lounge also and the home is waiting for them to be delivered. There were a number of residents in the home who were confused of suffered with dementia. There were instances where staff did not communicate with Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 14 residents, but talked among themselves when undertaking procedures and spoke in a very brusk manner. On discussion with residents it was stated some staff were good, but others could be abrupt. Feedback was also received that indicated some staff lacked attention to detail when undertaking procedures and in some cases they did not demonstrate a caring approach. On inspection of other records issues were identified with some staff’s attitude. At the time of inspection it was noted that some staff did not knock residents bedroom doors before entering, so infringing on their privacy. Also the handover in the morning entailed all staff on duty with the exception of one entering the resident’s room to be told they were all right. It is recommended that this practice be reviewed. Lockable facilities are available in bedrooms for residents to use for valuables or medication and locks had been fitted to bedroom doors enabling residents to lock them if they wish, so enhancing privacy. Curtains are fitted in shared rooms to ensure privacy is not compromised when personal care is given. A pay phone is available on the ground floor and a hands free set is available for use if privacy is required. Feedback was mixed with some stating they were satisfied with the care and others raised concern about the staff approach, attention to detail in care provided and the lack of staff knowledge. The medication was stored in a medication trolley and storage cabinets in the ground floor office, which were observed to be clean and organized so that medication could easily be located. However, the temperature of the room where medication was stored was too hot on occasions. This has been an issue for some time and action will need to be taken to ensure medication is stored at the correct temperature so they are stored within the product liability licence. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication for the current month it was found that the blister system was satisfactory. Approximately half the audits on boxed medication were not satisfactory. Although there had been improvements since the last inspection the following areas of concern were noted and will need to be addressed to ensure a robust system and residents receive the correct medication. • Some medication had been destroyed but the record had not been completed and the medication was not available in the appropriate container. • One resident had been admitted to the home with all medication in a liquid or dispersible form with the exception of one. The resident had refused the tablet and did not complete the course of antibiotics as required, but had taken all the liquid medication suggesting that if the tablets had been obtained in a liquid form they would have been taken. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 15 • • • In another case some medication had not been dispensed and staff had not followed it up so the residents did not receive the medication for a month. On occasions residents had been given extra doses of medication despite the instructions on the prescription. In one case a resident had been given medication for diarrhoea that was not prescribed, was not a homely remedy and there was no evidence that the resident had diarrhoea. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality and choice of food were not always suitable to meet resident’s preferences and ensure they received an adequate nutritious intake. There were no rigid routines and visitors could visit at time that suits them enabling residents to maintain contact with them. There is a lack of activities both inside and outside the home, so residents are not adequately stimulated. EVIDENCE: Visiting is flexible enabling relatives to visit at a time that suits them and residents to maintain contact with them. Feedback confirmed this and it was stated that drinks are offered on occasions. The home has an activity plan that includes bingo, music, beauty care, armchair aerobics, news update arts and crafts. On inspection of the records it was noted that residents birthdays and other events such as Easter and Christmas were celebrated with a cake and buffet on occasions. There was a visiting entertainer and progressive mobility organisation visited twice a month where exercises were undertaken. However, there was no evidence to demonstrate that the plan of activities was fully implemented as records stated Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 17 things such as television and sing song mainly. On discussion with residents they stated they were bored or fed up. There is a television in the main lounge/dining room; the design of the room and position of the television does not allow many of the residents to see it. During the afternoons of the inspection it was noted that staff played some appropriate music and the television was also on at the same time, which may be confusing. Also when visiting some of the residents room music was playing on the radio, but it was not the type of music that would be enjoyed by residents. Feedback was also received indicating that there was a lack of stimulation for residents. The home employs separate catering staff who provide breakfast and lunch and soup and sandwiches are prepared for the evening meal. There is a fourweek rotating menu, which provides a choice at meal times. There was no evidence of cultural options on the menu, but feedback stated curries were available sometimes. Some residents in the home are of Afro Caribbean backgrounds and they stated they would like more cultural foods. Residents were consulted about choices of food on the day of inspection. On discussion with residents some stated the food was all right, but on discussion with others they stated that it could be better or they did not like some of the meals provided. Records of food taken by residents were maintained generally demonstrating that choices were given. Seating was provided for a maximum of eight residents at the dining table in the lounge, but generally only three to four residents sit at the tablet to have their meal. The majority of residents were served their main meal on individual tables within the lounge where they had been sitting all morning. This does not promote the social aspects of dining and the lounge chairs provided may not enable the correct positioning of residents whilst they are eating. Additional seating was provided in the conservatory, but this facility is rarely used. The main meals served at lunchtime on the day of the visit were well presented and the portions of pureed diets were served separately in keeping with good practice, but no condiments were available. Staff provided assistance appropriately when required to residents sitting in the lounge. However, on touring the home it was found that one resident’s food had not been cut up to enable them to manage it appropriately themselves. In another case the bed table was too high for the resident reach the food and they needed some assistance. The evening meal consisted of soup and sandwiches and where residents received pureed food it was re-heated from the lunchtime meal. Diabetic meals and gluten free meals were provided to meet resident’s health needs. Fresh fruit and vegetables were available, but feedback indicated that residents were rarely offered fresh fruit as an option following meals. A full review of meals and mealtimes should be undertaken and action taken to ensure all residents needs are met appropriately and it a pleasant social event for residents. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems in the home for dealing with complaints and concerns are not robust enough to provide residents or their representatives with confidence that their views will be acted upon. The policies, procedures and staff knowledge about safeguarding procedures and not sufficiently robust to ensure residents are protected. EVIDENCE: The homes complaint procedure was satisfactory and there was a record of seven formal complaints since the last inspection. Some of the complaints related to inadequate standards of care and poor staff attitude. Although they had been recorded with the homes response there was no evidence that a full investigation had been completed, the complainant was satisfied with the response or that action had been taken to ensure there were no reoccurrences. Records clearly need to indicate these areas to demonstrate that the home has dealt with them effectively. Two of the complaints were of an adult protection nature and had been referred to Social Care and Health under the adult protection procedures in line with the guidance and procedures. They had not been upheld, but as a result of one the work pattern of the identified staff member involved in the allegation had been reviewed in order to safeguard residents. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 19 The Commission received one complaint recently that was referred to Social Care and Health under the adult protection procedures. A strategy meeting has been held and it is currently under investigation. Whilst inspecting other records it was found that two further concerns had been raised about staff attitude within the home that had not been recorded in the complaints file. The manager had called a staff meeting, which was held at the time of inspection to raise the issue with all staff, however there was no evidence that it had been addressed with the individual staff concerned. Also it was noted on another staff members file that issues had been raised about their performance and attitude. It was obvious that a warning letter had been sent to the member of staff. However, there was evidence of continued poor performance and no further action had been taken. The information provided by the home indicated that the policies and procedures had last been reviewed in February 2007. However, on inspection it was noted that he procedures had not been updated and the procedures in respect of adult protection and whistle blowing were not in line with guidance and this remains outstanding from the last inspection. A number of staff had received training in respect of the safeguarding procedures and on discussion they demonstrated very basic knowledge. Some lacked knowledge of the action to take in the event of an allegation and the whistle blowing procedures. Whist inspecting records it was noted that a resident had an injury to their eye, but there was no evidence that an accident form had been completed and there was no investigation into the cause of the injury. All accidents or injuries should be recorded and an investigation undertaken where the cause is not apparent. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a rolling programme of re-decoration and re-furbishment, which is being implemented in order to enhance the environment for residents. EVIDENCE: The home is generally well maintained. At the time of inspection the home was warm, there were some isolated areas of slight odour and some of the deep cleaning had not adequate e.g. behind beds. There is a large garden to the rear of the building, which was generally well maintained with patio area, and seating for residents when the weather permits. However it was noted that some of the garden furniture was damaged and needed treatment of replacement. There was also one area near the recent extension where the paving was very uneven and a potential risk to residents. This will need to be made safe with some urgency. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 21 There is one large lounge/dining room to the front of the property, plus a conservatory to the rear and a further two small lounges that could be used for a range of activities. However, the conservatory and small lounges are infrequently used. These areas are decorated to a good standard and new furniture is to be provided in the lounge/dining room that is mainly used, so enhancing the environment for residents. Although there are arrangements for heating and ventilation in the conservatory it was stated that it could get very hot or cold at times. This area will need to be reviewed to ensure a suitable temperature is maintained and residents can use the area. There are twenty-four single bedrooms and three double bedrooms and some have en-suite facilities. All bedroom doors had locks, so enhancing privacy. Also lockable facilities were available in bedrooms for the storage of valuables and medication if required. All rooms had a call bell to enable assistance to be summoned if required. There has been a programme of redecoration and refurbishment and a number of areas have been re-decorated, new carpets and furniture provided. Some rooms still require re-decoration and refurbishment and it was stated that three rooms are to be re-decorated and new carpets provided in the near future to further enhance facilities for residents. Whilst touring the home it was noted alarms on two pressurerelieving mattresses were alarming indication they were not working properly. Once this was raised with the manager action was taken, but it was concerning that this issue had not been identified by staff who had been caring for the residents earlier that day All rooms were individually and naturally ventilated and windows were provided with restrainers to ensure safety and security of residents living in the home. Radiators were of the low surface temperature type or covers were provided and water from hot water outlets was regulated to reduce the risk of scalding to residents There were assisted bathing facilities on each floor with a choice of bath or shower facility. Currently the bath on the ground floor is out of order and it was stated that this is to be replaced in the near future, so meeting the needs of residents who require assistance. Laundry facilities are situated to the rear of the property. It was fitted with two washing machines and dryers and separate staff take responsibility for laundering of linen and residents clothing. Feedback indicated that there were concerns about the return of clothing to residents and resident wearing other peoples clothing. This was discussed with the manager and he stated that action had been taken to address the issue in order to prevent re-occurrences. Some areas in respect of infection control were not adequate and need to be addressed to prevent the risk of cross infection e.g. wash bowls were on the floor, staff did not remove aprons and gloves after supporting residents, Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 22 The kitchen is situated on the ground floor and there were dedicated catering staff. Fridge, freezer and hot food temperatures were being recorded regularly, with the exception of the puree evening meal. On inspection it was cleaned adequately but it was noted that some foods that had been decanted or opened had not been dated, to ensure they were used within appropriate times scales. Some packets of food had been opened and had not been stored in a sealed container and potatoes were stored on the floor. Some of the chopping boards needed replacing. These area need to be addressed to ensure adequate food hygiene standards are maintained. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A review of staff levels and skill mix is required and action to taken to ensure residents needs are met. Further staff training is required to ensure staff have the necessary knowledge and skills to meet residents needs effectively. EVIDENCE: There is a manager in post who works five days per week between Monday and Friday. At the time of inspection staffing levels were maintained at one nurse plus six carers in the morning, one nurse plus five carers in the evening and one nurse plus two carers overnight. Although this meets the minimum staffing levels for the number of residents there were many areas that were not being addressed effectively. Therefore a review of staffing levels and skill mix of staff will need to be undertaken to determine the staffing requirements to meet the current residents needs. Where shortfalls are identified action must be taken to address the issues. Staff files were inspected at it was found that a fairly satisfactory recruitment process had been implemented with an application form, health declaration, two references and Criminal Record Bureau Check. However, it was found that some of the references were not from the most recent employer and some had not been signed, dated and there was no indication of the organisation the person worked for. One reference must be obtained from the most recent Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 24 employer where a person has been employed prior to applying for a post to ensure robust procedures and residents are protected. On inspection of files for some staff who had been employed in the home for a period of time it was found that work permits/visas were out of date. A system will need to be set up to ensure that they are alerted about renewal of documents for staff so that it can be followed up as staff from overseas who do not have the appropriate documents can not legally work in this country. It was stated that six care staff had achieved at least NVQ level 2 in care and further five staff were undertaking the training. Currently this is below 50 which is the minimum stated in the National Minimum Standards. This training is required to ensure staff have the relevant skills and knowledge to meet residents needs. On inspection of a sample of training records it was found that a large number of staff had under taken training in respect of prevention of abuse in 2006. Approximately six to seven staff had undertaken training in moving and handling, basic food hygiene, health and safety, infection control in 2005. There had been some recent training in respect of fire extinguishers, but on discussion with staff they were not aware of the action to take in the event of a fire, so putting residents at risk. Also staff had not undertaken regular fire drills, which are required to ensure they are fully aware of the procedure to follow in the event of a fire. The manager stated a company had been employed to provide basic training to staff over the coming year. The home had records of induction training that meets the standards of the Social Skills Council, which is to be completed over 12 weeks by new care staff. On inspection of the records of some new staff it was found that the induction training had been completed over one to three days and new staff had one day allocated for induction. This does raise questions about the quality of the training provided and whether new staff have the appropriate skills initially to undertake their role. This area will need to be reviewed. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management systems in the home are not sufficiently robust to protect residents or demonstrate how improvements are to be made. EVIDENCE: There is a registered manager in post who is currently undertaking the Registered Managers Award. Over the past year questionnaires have been introduced and are sent to families for comments and feedback about the quality of care provided in the home. Some positive feedback had been received and some areas had been highlighted that required attention. Feedback received by the Commission about these forms were positive; it was stated, “ They provide an opportunity to bring up issues that otherwise relatives might feel reluctant to raise and it Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 26 helps to negate problems that may arise due to staff changes etc”. The proprietors have started to have monthly meeting with the manager and copies of the minutes were available in the home. The quality assurance systems needs to be developed further and formalised to include feedback from all stakeholders, audits and a development plan indicating outcomes for residents to ensure continued improvement. The manager has held some meetings with nurses over the past year and it was noted that issues had been raised, but there was no evidence of follow up. There was only evidence of one staff meeting in 2006 and one at the time of inspection; almost one year apart. The manager has written to the Commission since the inspection stating that there had been a further two meetings, but there was no evidence of this at the time of inspection. Minutes of staff meeting should be made generally available to all staff to ensure good communication, as there will be some staff who cannot attend meetings. There was no evidence of formal supervision for staff to discuss progress, performance, training, philosophy of care, concerns etc in order to provide support/guidance for staff and address any concerns. During the inspection concerns were raised about some staff’s attitude and it appeared that it might be having an effect on team working. The above areas will need to be addressed and systems developed to enhance communication and team working and to address concerns raised. The arrangements for residents personal money to date has been that the home would invoice for extras such as hairdressing, chiropody etc. and receipts were available for chiropody. The system for hairdressing was not as clear and there was no evidence of the hairdresser’s insurance documents. The manager had recently received money for two residents and the deposit been recorded, but no transactions had occurred to date. The records in respect of maintenance and servicing of equipment etc were inspected and a number of areas had been addressed so that health and safety standards were being met. Areas that still require attention include; • • • There was no record of in house checks on the temperature of water form hot water outlets. Risk assessments in respect of building had been undertaken, but this needs to be developed further. Risk assessments in respect of cleaning fluids and chemicals had not been completed. There was no evidence of an up to date gas safety certificate, or certificate for the electrical wiring. Also there was no evidence that the fire stops had been tested on a regular basis. The current policies and procedures need to be reviewed and updated in line with guidance and good practice. It was stated that information had been received and work was to commence. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 27 Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 1 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 13 14 15 2 3 3 X 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 2 3 3 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 1 1 X 2 1 1 2 Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement Timescale for action 30/11/07 2. OP3 OP7 14 3 OP4 12(1) 18(1) Evidence that the people using this service or their representatives have been issued with a contract/statement of terms and conditions of residence at the point of admission to the home must be kept, so that it can be assured that they are aware of the terms of their stay in the home. Timescale of 30/10/06 and 15/3/07 not met. The registered person must 30/10/07 ensure assessments are fully completed for all residents who are admitted to the home so that staff are aware of their needs and systems put in place to ensure residents needs are met in a consistent manner. Timescale of 30/10/06 and 15/3/07 not met. 30/03/08 All staff must receive training in caring for people with dementia commensurate with their position in the home to ensure they have the appropriate skills and knowledge to care for residents. Timescale of 30/8/05 and DS0000061145.V338120.R01.S.doc Version 5.2 Abbeyrose Nursing Home Page 30 4 OP4 CSA 5. OP7 15 30/12/06 not met. If the manager wishes to admit residents outside their category of registration an application should be made to the Commission to vary their conditions. All care plans must include comprehensive assessment/risk assessments and include consultation with relevant others to ensure residents full needs are identified. The plan of care must outline in detail the action required by staff to meet residents needs and must include all areas of need or risk. The plan of care must be reviewed monthly and updated where there are any changes. Timescales of 30/8/05, 30/10/06 and 15/5/07 not met. Training should be given in the care planning system where required. 30/09/07 30/11/07 6. OP7 17(2) 7. OP8 12(1) 37 Systems must be in place to ensure all staff are aware of residents needs and the contents of care plans so that they can meet residents needs effectively. Systems must be in place to 30/09/07 ensure accurate daily recording related to residents care plans indicating care given and their condition/moods etc to reflect the condition of residents and care provided. All incidents or unexplained 30/09/07 bruising must be followed up and the cause investigated by senior staff. Where adequate explanations cannot be identified they must be reported to the resident’s social worker, and the DS0000061145.V338120.R01.S.doc Version 5.2 Page 31 Abbeyrose Nursing Home 8 OP8 12(1) 9. OP8 12(1) 10 OP8 12(1) 11 OP8 13(4) 12 OP8 12(1) 13 OP8 13(3) Commission to ensure residents are adequately protected. Neurological observations must be undertaken on any residents who sustain a head injury to monitor their condition, observe for any side effects and take appropriate action where necessary Systems must be in place to ensure that where aspects of care are monitored with the use of food, fluid, turn charts etc the care is implemented and monitored effectively by senior staff. This is to ensure resident’s needs are met and any concerns identified at an early stage so that appropriate action can be taken. Timescale of 20/9/06 and 15/3/07 not met. A review of all residents weight and BMI should be undertaken and where the BMI is below 20 appropriate actions taken to ensure residents receive adequate nutrition. A review of all bed rails should be undertaken to ensure they are safe for use (sufficient height, on both sides of bed, bumpers in position etc) and appropriate action taken where there are any deficiencies to prevent the risk of accidents. System smut be in place to ensure residents personal hygiene is undertaken to their preferences to include the choice of bath or shower, oral care, nail care etc., so their needs are met and they are comfortable. Where residents require a slide sheet for moving in bed an individual one should be provided for each residents at all times to reduce the risk of cross DS0000061145.V338120.R01.S.doc 30/09/07 30/09/07 05/10/07 15/10/07 15/10/07 15/10/07 Abbeyrose Nursing Home Version 5.2 Page 32 14 OP8 12(1)(1) (4) 15 OP9 13(2) 16 OP9 13(2) 17. OP15 16(2)(i) 18. OP16 22 infection Action must be taken to address the issues raised in respect of staff approach and attitude to residents to ensure they are treated with respect and their needs met Systems must be in place to ensure the accurate and administration of all medication to ensure residents receive medication prescribed to them. The medication room temperature must be maintained at 25 C or below to ensure that medicines are stored within their product licences. Timescales of 30/12/05, 20/09/06 and 1/4/07 not met. The registered person must undertake a review of the arrangements for meal times and food provided to ensure it is of a quality to meet residents needs, preferences and there are a choice of cultural options. Timescale of 30/9/06 and 15/3/07 not met. The registered person must ensure a record of all complaints/concerns is retained in the complaints file that indicates the nature of the complaint, the investigation, the outcome and resolution. Systems must be put in place to reduce the risk of re-occurrences happening. The registered person must ensure the adult protection procedures and whistle blowing procedures are updated and all staff are provided with training to ensure they are fully conversant with the vulnerable adult procedures. Timescale of 30/10/06 and DS0000061145.V338120.R01.S.doc 30/10/07 15/10/07 30/10/07 15/10/07 05/10/07 19. OP18 13(6) 30/10/07 Abbeyrose Nursing Home Version 5.2 Page 33 20 OP19 16(2)(c ) 23(2)(b) (c )(d) 21. OP19 23(2)(o) 15/3/07 not met. The programme of redecoration 30/12/07 and refurbishment must continue and any damaged furniture must be replaced. Furniture provided must be fit for purpose. This is in progress The registered person must 15/10/07 ensure the garden area is made suitable and safe for the residents to access. Timescale of 30/12/06 and 15/3/07 not met. Damaged garden furniture must be repaired or replace. All food items that are opened must be dated and used within timescales and they must be stored in appropriate containers. Food items must not be stored on the floor. To ensure adequate food hygiene standards. The temperature of food that is heated for the evening meal must be recorded to ensure it reaches adequate temperatures before serving. The double adaptor must be replaced with a more suitable system to ensure safety in the home. A review of the arrangements for the heating and ventilation in the conservatory should be undertaken and action taken to ensure it is suitable for residents to use in all seasons. Suitable systems for the prevention of infection must be implemented to include storage of washbowls and removal of protective clothing and washing hands after supporting a resident. A review of staffing levels and DS0000061145.V338120.R01.S.doc 22. OP19 16(2)(j) 05/10/07 23 OP24 13(4) 05/10/07 24 OP25 23(2)(p) 30/10/07 25 OP26 13(3) 15/10/07 26 OP27 18(1) 15/10/07 Page 34 Abbeyrose Nursing Home Version 5.2 27 OP29 19 28. OP30 16(2)(j) 17(2) 29 OP30 13(5) 17(2) 31 OP30 13(3) 17(2) 32 OP30 23(4)(d) (e) 17(2) 33. OP30 18(1) 17(2) skill mix must be undertaken and appropriate action taken to ensure residents needs are met at all times. A review of all staff files should be undertaken to ensure all documents are up to date. Where there are any shortfalls in documents appropriate action must be taken. All staff must undertake training in respect of basic food hygiene and records must be retained in the home to ensure staff have the appropriate knowledge and practice to maintain adequate hygiene standards in the kitchen and when handling food. Timescale of 30/3/07not met. . All staff must undertake updated training in respect of moving and handling residents, systems must be in place to ensure good practice at all times to ensure residents safety and records must be kept in the home. Timescale of 30/07not met. All staff must undertake training in respect of infection control and systems must be in place to reduce the risk of cross infection and. Records must be kept in the home Timescale of 30/3/07 not met. All staff must undertake updated training in respect of fire prevention and fire drills at least twice a year and be able to demonstrate the action to take in the event of a fire to ensure residents safety in the event of a fire. Timescale of 30/3/07 not met. Systems must be in place to ensure an effective induction programme for new staff to ensure they have the knowledge to care for residents initially. DS0000061145.V338120.R01.S.doc 15/10/07 30/11/07 30/10/07 30/01/08 30/10/07 30/10/07 Abbeyrose Nursing Home Version 5.2 Page 35 34. OP38 13(4) 23(2)(c ) Systems must be in place for regular servicing/testing of • Gas equipment. • The electrical wiring system in the original part of the home. • The fire stops on bedroom doors. 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP8 OP10 OP12 Good Practice Recommendations Residents should be consulted about the name they wish to be called and their preference in respect of the gender of staff to provide personal care. Arrangements are put in place for monitoring of chronic diseases such as diabetes, hypertension etc to ensure residents health needs are met effectively. All staff should knock residents bedroom doors before entering to ensure their privacy is respected. A review of the arrangements for seating in the lounge should be undertaken to enable residents to see the television if they wish. The television and radio in one area of the lounge should not be on at the same time as it may be confusing to residents. Residents should be consulted about the type of music or television programmes they want to ensure it meets their preferences. A review of the activity programme should be undertaken and should be based on residents past interests/hobbies etc. Then as appropriate plan of action should be put into place and implemented to ensure residents needs are met and they are adequately stimulated. Review the seating arrangements for mealtimes to provide a more social and pleasant experience for residents. Provide a manual peeler and bottle opener that can be used by or for residents. DS0000061145.V338120.R01.S.doc Version 5.2 Page 36 5 OP12 6 7 OP15 OP15 Abbeyrose Nursing Home 8 9 10 OP26 OP28 OP29 11 OP32 12 OP33 13 OP36 14 15 OP35 OP37 16 17 OP38 OP38 Ensure there is a programme of deep cleaning to ensure the environment is clean and odour free for residents. At least 50 of care staff should be trained to NVQ level 2 to ensure they have the appropriate skills and knowledge to care for residents. At least one reference should be obtained from the previous employer and they should be signed, dated and have the name of the organisation to verify staff competence and ensure a robust recruitment procedure. Regular staff meeting should be held in order to aid communication and team working in the home. Where any issues or concerns are identified they should be followed up and records should be available to demonstrate the action taken. The quality assurance system should be further developed to include feedback from stakeholders; audits etc and an annual development plan drawn up indicating outcomes for residents. Regular formal staff supervision should be undertaken at least six times a year to discuss staff performance practice, development etc. to aid team working and improve outcomes for residents. Evidence of insurance cover should be obtained from the visiting hairdresser. All policies and procedures should be reviewed and updated where necessary in line with guidance and good practice and systems put in place to ensure all staff are aware of them. Risk assessments in respect of the building should be further developed and risk assessment in respect of cleaning materials undertaken The temperature of water from all hot water outlets should be checked on a regular basis and records should be available in the home at all times. Abbeyrose Nursing Home DS0000061145.V338120.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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