Inspection on 22/01/08 for Abbeyrose Nursing Home

This inspection was carried out on 22nd January 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 but made no statutory requirements on the home.

Other inspections for this house

Abbeyrose Nursing Home 07/07/08

Abbeyrose Nursing Home 13/09/07

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 Kerry Coulter Key Unannounced Inspection 22nd January 2008 09:00 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.V357520.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.V357520.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.V357520.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. 13th September 2007 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 large lounge 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.V357520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 Three inspectors conducted the inspection over one day and the home did not know we were coming. This was the second 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 partial 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 inspectors so direct and indirect observation was used to inform the inspection process. One inspector spent two hours undertaking a short observation framework inspection (SOFI), which is an observation of people who are unable to communicate their care needs easily in order to determine their well being. Five people 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. What the service does well: Prior to coming to live at the home assessments of prospective residents’ care needs are undertaken in order to determine whether they can be met. Visiting is flexible and relatives said they were made welcome by staff. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 6 There are a variety of communal areas in the home, so providing a choice of areas for people to sit. Special events such as Christmas and Easter are celebrated, so enhancing the quality of life of people who live at the home. Progressive mobility visit on a regular basis providing a range of exercises, so maintaining some people’s mobility. Food stocks were good with a range of fresh fruit and vegetables so that people are offered a healthy diet. A system of obtaining regular feedback from relatives has been implemented through questionnaires to assist with improving quality in the home. What has improved since the last inspection? People have been provided with a copy of terms and conditions so that they have most of the information they need about their stay in the home. Relatives have been consulted about people’s likes and dislikes and this information has been included in peoples care plans. Staff seek advice from health professionals where specialist advice is needed to assist in meeting people’s healthcare needs. There are now more activities on offer to people, this includes the delivery of local papers and a visiting library service. Steps have been taken to ensure peoples religious beliefs are respected as links have been made with Ministers from different faiths who now visit the home. People are encouraged to eat in the conservatory action to provide a more social environment that and offers people the chance to mobilize more within the home. The menu has been reviewed in consultation with relatives and the dietician so that people are offered a varied and healthy diet. The Manager has also obtained a training pack from the dieticians regarding nutritional screening and is currently cascading this training to staff. The home has reviewed its adult protection policy and obtained a copy of the Birmingham Multi Agency Guidelines on adult protection and these should help staff at the home to follow safe procedures if there is a suspected incident of abuse. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 7 New seating and carpeting has been provided in the main lounge so that this is now a more pleasant area for people to spend time in. The home now has enough moving and handling and pressure relieving equipment to help meet people’s needs. The home have achieved the 5 star hygiene award from Birmingham City Council for its food hygiene systems. Improvements have been made regarding the administration of medication so that people should receive their medication in a safe manner. The systems in place for recruitment checks on all prospective staff members are robust so that people should be safeguarded. There is a rolling programme of staff training in place so that staff will soon have received the training they need. Improvements have been made to the induction training for new staff. The home now uses the induction pack provided by the Birmingham Care Development Agency. Formal staff supervision has been implemented to enable staff to receive support from the Manager. Maintenance records are better maintained and equipment is serviced regularly in order to ensure that it is safe to use. An external company has completed a health and safety audit of the home since the last inspection and was due to provide training to staff the day after the inspection. The Manager has completed additional training in safeguarding vulnerable adults, dementia, first aid and infection control so that he has the knowledge he needs to improve outcomes for people at the home. What they could do better: Care plans require further development so that staff have all the information they need to ensure people get the care they need in the way they prefer. Ensure that where people have been assessed at being at risk of pressure sores they receive appropriate support from staff to reduce the risk of pressure sores developing. Some areas of staff practice needs to improve to ensure people feel they are treated with respect and have a happy living environment. Activities and excursions should be provided that meet the needs and expectations of all people living at the home so that they have a good lifestyle. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 8 Arrangements must be made to ensure that people are better supported at mealtimes and food is presented in an appetising manner. Where people have bedrooms that lack personal possessions review with them or their relatives to establish if they would like their bedroom to be more personal and reflective of their age, gender and culture. The record of the outcome of all complaints investigations needs to improve so that people can be sure their complaints have been fully investigated and where needed action is taken to reduce the likelihood of future occurrences. Ensure that all staff are provided with training to ensure they are fully conversant with the vulnerable adult procedures. A review of staff allocation and daily routines must be undertaken in order to improve staff availability in the lounge. Continue to reduce the use of agency staff so that people are supported by permanent staff who know them well. Reports of monthly visits to the home must be available to ensure the Provider is monitoring that the home is being run in the best interests of people who live there. All staff must have regular training in respect of moving and handling people to ensure that people are assisted in a safe manner and not put at risk of injury. Safe manual handling techniques must be used at all times by staff to ensure people at the home are not put at risk of injury. 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.V357520.R01.S.doc Version 5.2 Page 9 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.V357520.R01.S.doc Version 5.2 Page 10 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, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are generally thorough so that the majority of people are able to make informed decisions about whether they would like to live at the Home. EVIDENCE: People who live at the home were observed to have been provided with a copy of the Service User Guide in their bedrooms. At the last inspection in September 2007 it was observed that a contract or terms and conditions needed to be provided to people funded by Social Care and Health to ensure they are aware of the terms of residency. This has now been provided to people and generally covers most of the things people need to know. The contract did not include details of the room allocated to people, it is recommended this information is included so that people are clear about which room they will have. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 11 A copy of the previous inspection report is displayed in the hallway of the home so that people have access to this information. The Manager undertakes a pre-admission assessment for all people wishing to move into the home. People come to stay at Abbeyrose on a four week trial period so that they have the opportunity to settle in to life at the Home. The pre-admission assessment for one person who was admitted to the home since the last inspection was looked at. This showed that the assessment is comprehensive and provided basic information enabling the Manager to decide if the home could meet their needs. Confirmation is given in writing that the home is able to meet prospective residents needs, so providing confidence to the person that their needs will be met following admission. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans require further development so that staff have specific details to assist people to meet their needs. The management of medication ensures that people receive their medication safely and as prescribed. Some areas of staff practice needs to improve to ensure people feel they are treated with respect. EVIDENCE: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. It was observed at the last inspection that some improvements were needed to the care plans. It is good that since the last inspection a likes and dislikes list has been completed by relatives and this information has been transferred into the persons care plans. At this inspection five care plans were reviewed either in full or in part. Care plans had improved since our last visit and generally reflected the current care needs of the individual person. Plans were seen to record the preferred name that people wished to be addressed as and their preference of staff gender for Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 13 personal support. Care plans could be improved further if people’s culture was taken into full consideration regarding the care they need. People seen during the inspection were seen to have been supported by staff with their personal care and were generally smartly dressed. For example, some people were wearing lipstick or nail varnish as appropriate to their gender. Further development of some plans is now required so that specific details are recorded in order for staff to assist people to meet their individual needs and preferences. For example some plans said people wore pads but the plans did not consistently state how often the pad should be changed what size pads the person may require. For another person who has contractures there was no mention of this in their care plan so that staff know what care they need. Personal risk assessments had been undertaken including the risks of people falling, use of bed rails, nutrition, pressure care and manual handling. One person had a care plan for maintaining a safe environment, this detailed that a lap strap should be worn when the person uses their wheelchair. There was no risk assessment for the use of the lap strap and guidance on its safe fitting. Some safety issues regarding the bedrails in use were identified at the last inspection. As a result the home has purchased a number of new rails. Some of these were seen to require adjustment to ensure they were as safe as possible. This was brought to the attention of the Manager who arranged for the handyman to make the necessary adjustments. Monthly weights were recorded so that changes could be identified and risk assessments for nutrition and sore skin were completed. Moving and handling assessments were detailed with the type and size of equipment to be used. However some information within assessments was seen to conflict with care plans, for example one document said one staff was needed whilst another said it was two staff when assisting one person to transfer. The home was observed to have sufficient numbers of slide sheets for use when assisting people to move. There was evidence of people receiving visits from external healthcare professionals including General Practitioners, Tissue Viability Nurse and Optician. Where advice had been sought from the Tissue Viability Nurse their recommendations were seen to be included in individuals care plans. Some staff practice in regard to pressure care needed some improvement. For example one person was observed to be sitting on a chair with their feet not touching the floor, this increases the pressure on their skin when sitting. Staff were observed to try and assist one person to change position in their chair. This person was shouting out, so staff lifted their legs onto a foot stool and put a pillow underneath. This did not relieve pressure to the sacrum. One persons records showed they had several falls recently, to try and find out why this has happened the home has referred the person to the falls clinic. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 14 Arrangements for the safe administration of medication were seen to be poor at the last inspection, action has now been taken and things have been put right. It has previously been a concern that the room where medication was being stored was too hot. The medication has now been moved to another room that is cooler so that it is stored properly. 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 for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. At the last inspection an audit was done of some of the boxed medication and some discrepancies were found. Boxed medication was audited at this inspection and found to be correct. Medication that needed to be stored in the fridge was being stored correctly, this included eye drops which were observed to have been dated on opening so that staff know when they need to be discarded. General observation and the use of the short observational framework (SOFI) showed that staff practice needed to improve so that people living at the home feel respected. Some practice observed was very good but most of this came from one particular member of staff. Whilst people generally got the practical care they needed some staff (including staff across all levels of seniority) were often seen to carry out care tasks with a person without speaking to them as they undertook the task. People were also referred to as ‘good girl’ and on one occasion one person was asked if they wanted to go ‘walkies’. Such language can be demeaning to people and not respectful that they are adults. One person was heard to ask where he was but no answer was given by staff, another person was wheeled out of the lounge by staff without being told where they were going. For some people, little interaction was observed with anyone at the home and staff need to make sure that all people have positive interactions throughout the day to ensure their emotional well being. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities to participate in varied activities are provided but needs to improve to ensure people have a lifestyle that meets their expectations and preferences. People are offered a varied and healthy diet but are not always offered culturally appropriate choices or supported appropriately at mealtimes. EVIDENCE: The people living in the home were seen to wander freely around the home where able due to mobility needs, spend time in their rooms if they wished, sit chatting in the lounge and take part in an activity. On the afternoon of the inspection people had the opportunity to take part in a ‘progressive mobility’ activity that was conducted by an external organisation. One relative commented that activities were on offer to people, one person commented that ‘it was a lovely place’. There is a television in the main lounge but as commented on in the previous report the design of the room and position of the television does not allow some people to see it. However staff were observed in the morning asking Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 16 people where they would like to sit in the lounge. One person said “I have today’s paper, I like to see the news on the TV”. They said they were unable to see the television from where they were sitting but would move if they wanted to watch it. At one point in the day a carer positioned one person in their wheelchair in front of the television, this resulted in other people having their view spoilt. People’s care plans include information on their activity preferences. For one plan sampled their plan recorded that staff should ensure they mix with other people who live at the home in the lounge. However discussion with the Manager indicated that this person was currently spending their time in bed. Consideration needs to be given as to how social contact can be maintained as much as the person is able. The home does not have a dedicated activities coordinator and staff assist people with activities. The home has an activity plan that includes bingo, music, beauty care, armchair aerobics, skittles, ball games, news update, sing songs, manicures and arts and crafts. At the last inspection it was identified that the plan was not always fully implemented and that activities were usually the television and sing songs. Activity records show that the range of activities has improved and that the activity plan is usually followed. Some new leisure activities have been introduced to include a visiting library service and the provision of daily newspapers. Steps have also been taken to ensure peoples religious beliefs are respected as links have been made with Ministers from different faiths who now visit the home. A hairdresser visits every week to tend to individual hair requirements. Some further work is needed to ensure that everyone has the opportunity to participate in stimulating activities that they enjoy. For two people the activity records showed some gaps of several days where there were no recorded activities or explanations why they had not taken place. For one person the records showed that they often did not participate in activities because they were asleep. The home should consult with the person to see if they want to be woken for activities or ensure that staff offer alternative activities to them when they are awake. Discussion with the Manager and observation of the development plan for the home indicates that further improvements are intended to take place. Consideration is being given to appointing an activities co-ordinator and to have a notice board for events, newsletter and vegetable plot and raised beds in the garden. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 17 Visiting is flexible enabling relatives to visit at a time that suits them and residents to maintain contact with them. Visitors were seen to come and go throughout the inspection and appeared to be made welcome by staff. One of the visitors commented they were able to stay for a meal if they chose to but that that they never had, they felt that overall the home offered a good service. One visitor said that a party had been held in the home at Christmas and relatives had been invited to attend. The home employs separate catering staff who cook the meals in the home. One of the cooks was spoken with who confirmed the food budget for the home was satisfactory and that there were twice weekly deliveries to the home of fresh fruit and vegetables. Observation of food stocks showed there was lots of fresh fruit and vegetables available. Fresh vegetables was observed to have been used in the soup for tea time and fruit had been used in one of the deserts. The home has a four-week rolling menu which have been reviewed since the last inspection to provide a more balanced diet. Consultation has also taken place with relatives of people who are unable to communicate their food preferences. The information gathered from the consultation has been used in developing the menus. The Manager stated that the home to introduce the NUTMEG nutritional analysis system, which is a software package, which helps to plan a balanced meal. The Manager has also obtained a training pack from the dieticians regarding nutritional screening and is currently cascading this training to staff. Diabetic meals and gluten free meals were provided to meet people’s health needs. There are different options for each meal of the day but as identified at the last inspection there was little evidence of cultural options on the menu. Some people in the home are of Afro Caribbean backgrounds and at the inspection in September 2007 they stated they would like more cultural foods. Since the last inspection the conservatory is being utilized as a dining area but some people still choose to eat in the main lounge on small tables. It is good that the conservatory is now being used as this gives people the chance to mobilze more and spend time in a different area of the home. The main meals served at lunchtime on the day of the visit were well presented and the portions of pureed diets were served separately by the cook in keeping with good practice. Unfortunately some staff mixed all the pureed portions together before serving to people, this resulted in people being unable Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 18 to experience the different textures and tastes of the food. After the inspection the Commission was sent evidence that a meeting had been held with staff where they were reminded about how the pureed food should be served. The short observational framework (SOFI) was undertaken during the lunchtime meal and this showed that staff practice was sometimes satisfactory but was often poor. Interactions were generally task based and staff often missed the opportunity when assisting people with their meal to make it a more socially enjoyable experience. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 19 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which is accessible to people who live at the home and their representatives if they need to make a complaint. There are systems in place that should protect people from harm but not all staff have received training in protecting people from abuse. EVIDENCE: The homes written complaint procedure was satisfactory and a form for making complaints or suggestions was readily available in the hallway. The development plan for the home indicates it is intended to introduce a suggestion box so that people can voice their opinions on any aspect of the home. One relative spoken with said that staff very approachable and any concerns could be raised. They gave an example of where a minor concern had been appropriately responded to by staff. There was a record of five complaints since the last inspection. Two of these were minor in nature and involved parking facilities and arrangements for drinks and snacks when taking people to the hospital. Two of the complaints detailed in the complaints log were originally received by the Commission and were passed to the Provider to investigate. For one of the complaints there was information about the outcome of the investigation, discussion with the Manager indicated that the complainant had been written to with the outcome and was satisfied. However, there was no evidence to reflect this in the complaints folder. For the second complaint passed to the Provider to investigate the Manager said the investigation had been completed and a letter Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 20 sent to the complainant. Details of the investigation or letter to the complainant were not available. As found at the last inspection records clearly need to indicate the actions taken following receipt of a complaint to demonstrate that the home has dealt with them effectively. At the last inspection it was identified that the home’s policy and procedure in respect of adult protection and whistle blowing were not in line with current good practice. These have now been updated. The home has also obtained a copy of the Birmingham Multi Agency Adult Protection Guidelines and these are readily available to everyone in the hallway of the home. Some staff lacked knowledge of the action to take in the event of an allegation and the whistle blowing procedures at the last inspection. Since then the Manager has updated staff on the whistle blowing procedure at two staff meetings. Some staff have had adult protection training but not all staff have done this however further training is scheduled. One member of staff was spoken with about their knowledge of adult protection procedures, whilst their knowledge was basic the actions they described would generally safeguard people from abuse. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 21 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): 19, 22, 24, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are generally provided with a homely, clean and comfortable environment in which they feel safe and secure. Aids and adaptations provided are fit for purpose and for the needs of people using the service. EVIDENCE: The home is generally well maintained. At the time of inspection the home was warm and odour management was generally satisfactory. The lounge area was very warm and may be uncomfortable to people if they spend most of their day there. Several people in this room were asleep and the temperature of the room may contribute towards people feeling sleepy. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 22 There is a large garden to the rear of the building, which was generally well maintained with patio area, and seating for people when the weather permits. Since the last inspection the damaged seating has been repaired so that it is safe for people to use. It was identified at the last inspection that there was some uneven paving in the garden. The Manager said that the paving in this area had been re-laid but it was still seen to be uneven and may have posed a tripping hazard to people. An immediate requirement was made for the area To be made safe. Following the inspection the Manager forwarded evidence that new slabs had been purchased and said that the home’s handyman had now made the area safe. There is one large lounge to the front of the property, plus a conservatory to the rear and a further two small lounges. The lounge was previously split into a dining area but the conservatory is now used as the main dining room. Since the last inspection some new carpet has been fitted and new seating purchased for the lounge. At the last inspection it was identified that sometimes the conservatory could be too hot or cold. To try and make sure the room is at a comfortable temperature additional heaters and air conditioner units are in use. The home will need to continue to monitor the temperature to make sure it remains comfortable. The room that was previously used for medication is now a small sitting area that has a music centre some sensory lighting. The Manager said this room could be used by people who wished to have some relaxing time or meet privately with relatives. There are twenty-four single bedrooms and three double bedrooms and some have en-suite facilities. Six bedrooms were looked at and these were generally maintained in good decorative order, although one was looking a little shabby and had scorch marks above the radiator. This room was also observed to have a crack to the external pane of glass and although not a safety risk will need repair so that it is in good condition. One bedroom needed a new vanity unit or satisfactory repairs as the wood on it was split. One relative said that their Mother had recently had a new carpet installed that had been paid for by the home, they felt that the bedroom met their needs. Some bedrooms seen were very personalised with people’s own possessions but others were quite sparse. The Manager said he would contact people’s relatives to see how the bedrooms could be made more personal. Equipment provided at the home appears to meet people’s needs. There were some “profiling beds” available. These promote the comfort and dignity of people with high dependency needs, limited mobility and residents who spend prolonged periods of time in bed. The Manager said the home had recently purchased a ‘stand aid’ that will be used to assist people standing once staff have been trained on its use. All rooms had a call bell to enable assistance to be summoned if required. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 23 The kitchen is situated on the ground floor and there were dedicated catering staff. Fridge, freezer and hot food temperatures were being recorded regularly to ensure that food is stored or served to people at safe temperatures. Since the last inspection new colour coded chopping boards and knives have been purchased to improve food hygiene. Evidence was seen that the home have achieved the 5 star hygiene award from Birmingham City Council. Laundry facilities are situated to the rear of the property. These were not observed at this inspection. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 24 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home maintains adequate staffing levels to meet the individual needs of people who live at the home. A staff training programme is underway to ensure they have the knowledge to perform competently within their roles. The recruitment procedure is robust and ensures that people are safeguarded from harm. EVIDENCE: There is a Manager in post who works five days per week between Monday and Friday. Since the last inspection a Care Co-Ordinator has been employed to work part time in the home to assist the Manager in improving the care provided. On the day of the inspection in addition to the Manager and Care CoOrdinator there was one nurse and five carers on duty. In addition to care staff the home also has domestic, kitchen and maintenance staff to help meet the needs of the people who live there. The numbers of staff on duty are satisfactory but due to staff sickness two of the staff on duty were agency staff and so they were not as aware of people’ needs as the permanent staff. This results in people being supported by staff they do not know that well, although the home does try and use the same agency staff to provide some consistency. At one point in the morning it was observed that there were no staff in the lounge. One person was leaning forward in their chair and another was attempting to get up. A relative commented that there are hardly ever any Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 25 staff around and they worry about people falling. The home needs to ensure that staff are providing safe levels of supervision to people. One relative spoken with said that staff were approachable but that there were too many agency staff. Discussion with the Manager indicates there has been regular use of agency staff as five staff have left the home since the last inspection. The Manager said that some staff had left as they were unable to provide evidence they were eligible to work in this country and others had left due to poor work performance. The use of agency staff is reducing as some new staff have been recruited and one new staff is due to start pending suitable recruitment checks. The Manager said that there were still two vacancies that they hoped to recruit to soon. Training records and discussion with the Manager showed that nine care staff had achieved at least NVQ level 2 in care or equivalent qualification and other staff were undertaking the training. This meets 50 of staff being qualified to ensure staff have the relevant skills and knowledge to meet people’s needs. Two staff recruitment files were reviewed and these contained all the required information to show a robust recruitment procedure to ensure that people were safe from harm. At the last inspection issues were identified regarding seeking references from previous employers and proof of staff’s eligibility to work in the United Kingdom. Since then references have been obtained for new staff from their last employer and an audit of all staff has been undertaken regarding eligibility to work. Staff who were unable to provide proof of eligibility have ceased employment at the home. Since the last inspection improvements have been made to the induction training for new staff. The home now uses the induction pack provided by the Birmingham Care Development Agency (BCDA). As part of this, staff complete a workbook based on Skills for Care and this will assist in the provision of a knowledgeable workforce. At the last inspection requirements were made in relation to training as there were several areas where staff had not had recent training or had demonstrated a lack of knowledge. Since then a full training program has been implemented for staff, conducted by an external training provider. The training schedule showed that some training has already taken place with other training sessions planned. Four staff undertook health and safety training in October and twelve staff were booked to do this the day after the inspection. Eleven staff did manual handling training in November and further sessions were booked for February and May. Staff have recently completed first aid, and protection of vulnerable adults training, further training for the rest of the staff team is booked. One of the requirements from the last inspection was for staff to have dementia training, four staff have now done this, the rest are doing this soon. Staff had done infection control training and further training is booked for staff who had missed this training. Two nurses and one senior carer Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 26 undertook tissue viability (pressure care) training in November. One staff spoken with confirmed that they had recently received lots of training and felt well supported. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 27 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress had been made in ensuring that the home is improving for the benefit of people living there. Further improvement is needed to some health and safety practices so that people are not being put at risk. EVIDENCE: The home has a Manager in place who is registered with the Commission. He is a qualified nurse and has recently completed the Registered Manager’s Award. To try and improve the care provided at the home the provider has employed a Care Co-ordinator who works part time. This gives additional support to the Manager and staff. At the last inspection there were a number of areas of concern about this home and it is good that the Manager has done further training in some of Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 28 these areas to improve his knowledge. Training undertaken has included ‘train the trainers’ safeguarding vulnerable adults, dementia, first aid, infection control, and fire extinguisher training. The Manager also moved his office from the second floor of the home to the ground floor so that he is more accessible to staff, visitors and people who live at the home. It is evident that improvements have been made in the home and it is acknowledged that the Manager needs time to sustain and continue with improvements. However, an important part of being a Manager is to ‘model’ good practice with other staff. The Manager and other senior staff within the home were observed to work with people without using the time to provide good social interactions. On some occasions care staff were observed supporting people inappropriately and this did not appear to have been addressed with staff at the time. Over the past year questionnaires have been introduced and are sent to relatives for comments and feedback about the quality of care provided in the home. The Manager had collated the responses into a report and indicated what action had been taken in response to any improvements needed. No new questionnaires have been received by the home since the last inspection. A number of internal audits have been completed since the last inspection to include medication and staff recruitment files. The Manager has also introduced a new infection control audit for the kitchen that is to be completed monthly. The Manager said that the Owner visits the home on a weekly basis and has monthly management meetings. However there were no reports available of the Owners visits or minutes of management meetings. The Owner agreed after the inspection to forward copies of these meetings but they had not been received at the time of writing this report. It is good that the Manager has met with the Care Co-ordinator to work on a development plan for the home. Some improvements planned for the future a are notice board for future events, a suggestion box, new position of activities co-ordinator, self audits, and having raised beds and vegetable plots in the garden. The arrangements for personal money to date has been that the home would invoice for extras such as hairdressing, chiropody etc. There had been no changes regarding the management of peoples’ money since our last visit. Minutes of staff meetings showed that they are generally held regularly so that all staff are kept updated with the changing needs of the people living there, ‘best practice’ and any changes happening within the home. The frequency of the meetings has increased since the last inspection and minutes of staff meetings are available to all staff to ensure good communication. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 29 At the last inspection there was no evidence of formal supervision for staff to discuss progress, performance, training and philosophy of care in order to provide support and guidance for staff and to address any concerns. This has improved and staff are now receiving supervision. It is good that as part of the supervisions the Manager often works alongside the member of staff so that they can discuss practice issues. Minor improvement is needed to make sure staff have supervision on at least a two monthly basis. In addition to supervision the Manager and Care Co-ordinator have recently implemented individual performance reviews with staff that will be done on an annual basis. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Water temperature checks are recorded each month and this assists in the prevention of people accidentally scalding themselves. Maintenance checks are completed on the fire system and equipment and staff receive fire training and drills so that people should be safe in the event of a fire occurring. One member of staff was spoken with about the fire procedure in the home. Whilst the staff did not seem that confident in their responses the actions described would protect people in the event of a fire occurring. An external company has completed a health and safety audit of the home since the last inspection and was due to provide training to staff the day after the inspection. Since the last inspection West Midlands Fire Service has issued a notice instructing the home that one of the bedrooms cannot be used until a safety issue with a nearby staircase is resolved. The Manager confirmed this room was currently not in use. As indicated earlier in this report there were some safety issues with regards to bedrails and uneven paving, information provided at the end of the inspection and a few days after indicates these areas have been made safe. Whilst many areas of health and safety had improved since the last inspection the moving and handling practices observed often put people at risk of injury. Two staff were observed trying to persuade one person into a chair using a frame, this was unsuccessful. The Care Co-ordinator later came in to the room and said that a hoist was needed for this person. Staff were observed assisting one person to stand by telling them to hold onto a frame as they stood. The frame had wheels on and so could have easily moved as the person stood. When the person did succeed in standing staff did not turn the frame around resulting in the person being twisted. Of a high concern was that on several occasions staff were observed transferring people by using an underarm lift. This type of lift should not be used as it puts the person at a high risk of injury. When staff were assisting Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 30 one person to transfer they had to be asked to stop by an Inspector due to the high concern about the risk of injury to the person. Due to the potential risk to people living at the home an immediate requirement was made to ensure safe manual handling techniques were used by staff a the home. Following the inspection the Manager forwarded a copy of a staff meeting that had been held with staff to reinforce good practice. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 31 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 2 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 3 X 2 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X 1 Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15(1) Requirement Ensure that information within care plans and assessments does not conflict so that staff have accurate information on how to meet peoples needs. Where a risk has been identified to someone living at the home a detailed risk assessment must be completed showing how the risk is to be safely managed. Ensure that where people have been assessed at being at risk of pressure sores they receive appropriate support from staff to reduce the risk of pressure sores developing. 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. Previous requirement from 05/10/07. Ensure that all staff are provided with training to ensure they are fully conversant with the vulnerable adult procedures. Timescale for action 30/04/08 2 OP7 15(1) 30/03/08 3 OP8 12(1) 30/03/08 4 OP16 22 30/03/08 5 OP18 13(6) 30/04/08 Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 33 6 OP27 18(1) 7 OP30 18(1) Previous requirement (date for training is scheduled). A review of staff allocation and daily routines must be undertaken in order to improve staff availability in the lounge. 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 people. Previous requirement but date for compliance not yet passed. All staff must have regular training in respect of moving and handling people to ensure that people are assisted in a safe manner and not put at risk of injury. 30/03/08 30/03/08 8 OP30 18(1) 30/03/08 9 OP33 26 10 OP38 13(4) Previous requirement. Training scheduled to take place. Reports of monthly visits to the 30/03/08 home must be available to ensure the Provider is monitoring that the home is being run in the best interests of people who live there. Safe manual handling techniques 24/01/08 must be used at all times by staff to ensure people at the home are not put at risk of injury. Immediate requirement made at inspection visit. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 34 No. 1 2 3 4 Refer to Standard OP2 OP7 OP7 OP10 Good Practice Recommendations Contracts should detail the room allocated to people who live at the home so that they are aware of all the terms and conditions of their stay. Care plans should include more information about how individual’s cultural needs should be met so that people are supported in the way they prefer. Some care plans regarding people’s personal care needs would benefit from further detail so that staff know the exact support that people need. Arrangements should be made to ensure that all staff are aware of the importance of good interactions with people who live at the home in order to promote a homely and happy living environment. A review of the arrangements for seating in the lounge should be undertaken to enable residents to see the television if they wish. Activities and excursions should be provided that meet the needs and expectations of all people living at the home. Review the mealtime arrangements to ensure culturally appropriate food is on offer to people and pureed meals are presented in a tasty and appetising manner so that people can enjoy their food. Staff should use the time spent with people during mealtimes to make it a more socially enjoyable experience through positive interactions. Monitor the temperature in the lounge to ensure it is comfortable for people who live in the home. Undertake repairs and redecoration to bedrooms as identified as needed in this report to ensure people have a bedroom that is well maintained and meets their needs. Where people have bedrooms that lack personal possessions review with them or their relatives to establish if they would like their bedroom to be more personal and reflective of their age, gender and culture. Continue to reduce the use of agency staff so that people are supported by permanent staff who know them well. Staff should undertake training in respect of infection control to ensure there are good infection control procedures in the home. Managers and senior staff within the home should model good working practice to other staff and take action where they see poor staff practice to make sure that people get the care they need. Regular formal staff supervision should be undertaken at least six times a year to discuss staff performance DS0000061145.V357520.R01.S.doc Version 5.2 Page 35 5 6 7 OP12 OP12 OP15 8 9 10 11 OP15 OP19 OP24 OP24 12 13 14 OP27 OP27 OP32 15 OP36 Abbeyrose Nursing Home practice, development etc. to aid team working and improve outcomes for residents. Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 36 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. Extracts may not be used or reproduced without the express permission of CSCI Abbeyrose Nursing Home DS0000061145.V357520.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!