Inspection on 07/07/08 for Abbeyrose Nursing Home

This inspection was carried out on 7th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abbeyrose Nursing Home 22/01/08

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Abbeyrose Nursing Home 38 Orchard Road Erdington Birmingham West Midlands B24 9JA Lead Inspector Karen Powell & Rebecca Harrison Unannounced Inspection 7th July 2008 09:55 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.V368004.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.V368004.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.V368004.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. 22nd January 2008 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. 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 £467.00 to £670.00 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 Inspection reports produced by CSCI can be obtained direct from the provider or are available on our website at www.csci.org.uk Abbeyrose Nursing Home DS0000061145.V368004.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 2 stars. This means the people who use this service experience good 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 This inspection was unannounced and carried out by two inspectors over four and a half hours. A range of evidence was used to make judgements about this service to include discussions with some people who use the service, relatives, staff on duty, a tour of the home, a review of the homes quality assurance processes and observation of care experienced by people using the service. We also looked at a number of records to include care records held on behalf of two people, complaints and protection, staff training, recruitment and health and safety records. Due to the needs of the people living at the home not all individuals were able to actively contribute to the inspection process and share their own experience of living at Abbeyrose, therefore direct and indirect observation was used to inform the inspection process. Two 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. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the manager for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. What the service does well: Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 6 People are assessed to ensure the home are able to meet their needs prior to admission. There is a clear care planning and review system in place. The health care needs of people are met in a sensitive and professional manner. People who use the service are respected and treated with dignity and their privacy is maintained. People are able to have flexible daily routines, social activities are tailored to meet individual needs. The home has policies and procedures in place that protect people from abuse and promote the legal rights of people using the service. Staff are trained in safeguarding adults. There is a clear and accessible complaints procedure in place. People who use the service and their relatives are encouraged to raise their concerns, complaints and compliments. The environment is well maintained, clean and tidy. The home recognises the need to have a trained and supervised staff group. They continue to develop their training programme along with structured supervision for staff. The health, safety and welfare of people living at Abbeyrose is promoted by regular safety checks and maintenance of equipment. A quality assurance process has been developed that takes into account the views of people who use the service and that of their relatives/representatives. What has improved since the last inspection? Care plans are comprehensive and more personalised. They contain risk assessments for tasks that pose a risk to the individual and staff and now show how risk is managed. Individuals who have been identified as being at risk of developing pressure sores now receive appropriate support from staff to reduce the risk of them developing. The central record of complaints now details a record of the complaint, investigation and outcome/action taken. People are encouraged to voice their concerns/ideas about how to improve the service. A suggestion box is now located in the halls reception. There is a meeting for relatives arranged in the very near future. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 7 A revised training programme is in place and the majority of staff have completed dementia care and safeguarding adults training with exception of new staff. Opportunities for activities have improved. The home has interacted with the local community and local groups are being invited to have involvement within the homes activity programme. The homes décor has been improved and people living at the home were involved in choice of colour for their bedrooms and communal areas. Colour samples were obtained to assist people with their choice. New furniture has been purchased for some rooms. A new bath and two hoists have also been purchased in addition to individual slide sheets, which are now located in people’s own rooms. Pressure relieving mattresses have been replaced. There has been a reduction in the use of agency staff. We noted only 3 shifts covered by agency staff since the last inspection. The home has successfully recruited some new staff. Staff are now receiving supervision at the required frequency. Quality assurance surveys have been distributed and the findings collated. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbeyrose Nursing Home DS0000061145.V368004.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.V368004.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): 3 Quality in this outcome area is good People looking to move into the home can be confident that the care home can support them. This is because there is a complete assessment of their needs that they, or people close to them, have been involved in and they are able to make an informed decision about whether they would like to live at Abbeyrose Nursing Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was stated on the AQAA that “all residents are assessed prior to admission to the home to ensure that we can meet their needs.” We looked at the file of the newest person admitted to the home. We found that the registered manager had carried out a comprehensive assessment of the individual’s needs. This had taken place prior to the individual moving into the home, as stated in the completed AQAA. Through discussion with the registered manager and examination of the assessment documentation it is evident that information was gained from a number of sources, including health care Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 10 professionals to obtain a clear picture of the individual. This was particularly important because the individual concerned was unable to communicate their needs to the manager due to their disability. The completed AQAA told us that “Prospective residents and their families are given the opportunity to ask questions and to come for trial visits before making the final decision to come and live at Abbey Rose.” The persons family was able to visit the home to look round and meet the staff and other people living at the home before making a decision about their relative moving in. Abbeyrose Nursing Home DS0000061145.V368004.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 good Service users’ care needs and risk assessments are set out in their individual plans of care, which have been improved, to ensure staff are provided with sufficient information for the delivery of care. The management of medication ensures that people receive their medication safely and as prescribed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We made three requirements in relation to this outcome group at the last inspection. These related to accurate information being contained in the care plan for staff to be able to understand how to meet an individuals needs. We required that risk assessments must be in place for all tasks that posed a risk to the individual and staff member. Finally, we required that where people Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 12 have been assessed at being at risk of pressure sores they receive appropriate support from staff to reduce the risk of pressure sores developing. We examined the care plans of two people living at home in detail. Both care plans were seen to be well documented and an accurate reflection of their assessed needs. It was stated on the completed AQAA that “ each resident has a care plan drawn up based on his/her needs and discussed along with family members. Where a plan of care requires us to involve other disciplines such as tissue viability nurses or dieticians, we refer for specialist advice.” We saw that the home had sought the advice of the dietician where particular problems had been experienced with one individual. We also saw records of other healthcare professionals involved in peoples care, for example the optician and a dentist. Care plans were personalised and we saw information to prompt staff to remember to explain to people what they are assisting them with before undertaking the personal care or support required. When looking at the bedrooms of the two people we case tracked we saw copies of their care plans readily available for staff to consult with if required. We also saw detailed risk assessments where required in relation to the individual needs of the two people case tracked. When we observed the care for these individuals it was noted that care staff were following the risk assessments produced. For example we looked at how people were safely transferred, and how staff reduced the risk of pressure sores developing for both individuals. We saw documents in relation to fluid intake and turning charts satisfactorily completed in one individuals bedroom that we case tracked. The requirement to do this had been documented in the care plan. The individual looked comfortable and well cared for, pressure-relieving equipment identified in the care plan was seen to be in place. It was discussed with the homes manager that where bed rails are in use consent for the use of these should be obtained from the resident or their next of kin. This was not documented in the case of one of the individuals case tracked where we saw bed rails in use. We spoke to four individual visitors who were visiting their relatives/friend on the day of the inspection. All visitors were very positive about the care delivered to their relative/friend. In the case of relatives spoken to they told us that they are always kept in touch regarding any changes to their relative. One relative said, “I am very happy with the home, staff do a brilliant job. I am very pleased with the care, staff are very kind. They respect my relative’s privacy and dignity when caring for them. I am always made very welcome here.” Another relative told us “I visit the home every day, my relative is always well cared for, I am very happy with the home.” Care plans made reference to promoting privacy and dignity and throughout the inspection we observed staff respectfully speaking to individuals. We also observed staff explaining what they were about to assist people with. People who were able to contribute to the inspection told us that if they received mail at the home it was given to them unopened. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 13 Medication administration procedures were observed at the lunchtime medication round. These were observed to be safely followed in line with current safe good practice. The nurse completing the medication round confirmed that there are currently no controlled drugs in use at home. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 14 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 good Opportunities to participate in varied activities has improved ensuring people living at the home are involved in daytime activities of their own choice and according to their interests and capabilities. People are enabled to keep in contact with family and friends. People who use the service receive a healthy, varied diet according to their assessed requirement and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who were able to mobilise independently were observed to access all parts of the care home as they chose. People using the service told us they were able to rise and retire as they wished, see their family and friends when they chose and to take part in the activities that are now available at the home if they wish. A recent summer fayre held at the local church was attended by some individuals. Forthcoming activities were publicised on the homes notice board, including a barbecue. The care co-ordinator told us it is the homes intention to keep a photograph album of events that take place in the home Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 15 and the local community. On the day of our visit the hairdresser was visiting the home and people were enjoying having their hair done. Visitors were seen to come and go during the day and told us that they are always welcomed into the home. It was clear through discussion with them that they vary the times of their visits and are happy with these arrangements. There is a four-week menu in place at Abbey Rose, we spoke to the cook who explained he takes into consideration individual dietary needs, likes and dislikes of people using the service. He explained to us how he has tried to include a variety of dishes that are traditional and appropriate to the season which meet people’s individual needs. The menu was seen and considered to offer a healthy well balanced varied diet. Special diets were seen to be well catered for. The lunchtime meal was observed to take place in the conservatory for those people who wish to eat it there. Tables were nicely laid with clean linen cloths, condiments and flowers. The meal was well presented including puréed meals in keeping with good practice. People told us they enjoyed the meal and the food generally offered at the home. Where people had chosen to eat in the lounge their meals were delivered to them plated and covered. People requiring assistance were given this and staff were observed to explain to people that they were about to help them with their lunch. Choices of drinks were offered to people throughout the lunchtime meal. We observed that the lunch time meal was relaxed and evidenced as something the home does well in their completed AQAA. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 16 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 good The service has a complaints procedure, which is accessible so that people who use the service know how to make complaints about the home. Staff now receive training so that they have a greater understanding in adult protection to ensure people who use the service are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home have placed a suggestion box in the homes reception for people to voice their opinions on any aspect of the home. One relative spoken to gave an example where they raised a concern to the manager about an agency staff member. This was dealt with to their satisfaction. We made two requirements at the last inspection relating to this outcome group. We required the home ensures a record of all complaints are retained in the complaints file indicating the nature of the complaint, the investigation and the outcome. We also required that all staff should be provided with training to ensure that they fully understand the vulnerable adult procedures. We considered that the home have met both requirements. The manager confirmed that there has been one complaint received since the last inspection. We looked at the complaint record to monitor how the Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 17 complaint received had been recorded. We found that it recorded the investigation, outcome and action taken. We have not received any concerns, complaints or allegations since the last inspection of the service. Twenty six staff have now received training in the protection of vulnerable adults. Staff spoken with considered the training has equipped them with the knowledge to meet the individual needs of the people living at the home and procedures safeguard people living at Abbey Rose. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 18 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): 19,20,22,23,24,25 and 26 Quality in this outcome area is good The environment has much improved to ensure people living at Abbeyrose are provided with a homely, clean and comfortable place to live where they feel safe and secure. The home makes sure they have the right specialist equipment that encourages and promotes their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken with during the inspection indicated that they enjoy living at the home and that their rooms are comfortable. Rooms seen were personalised with family photos and ornaments. Staff felt that people living at the home have benefited from the redecoration of a number of rooms and replacement of some floor coverings and furniture. One member of staff said “I can see real improvements with the owners and environmental improvements generally”. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 19 People living at the home are provided with a range of communal areas to use to include a large lounge to the front of the property and two small lounges. The home provides a spacious conservatory to the rear, which is used as the main dining room. An additional room is available for people to meet their visitors in private or for meetings and reviews to be held. Included in the completed AQAA and considered by the home as something they do well was a statement that home provides a “homely atmosphere, odour free, house cleaning every day, residents are encouraged to bring their personal possessions so that the rooms are set to their liking.” We supported this view following discussion with people living at the home, families/friends and a tour of the home. The home provides twenty-four single bedrooms and three double bedrooms and some have en-suite facilities. One of the single bedrooms is currently not being used following a visit from the Fire Officer last year as the staircase next to the room is not capable of facilitating the safe evacuation of residents. The manager told us one of the double rooms is only occupied by one person as they have requested not to share a room therefore this request is being upheld. A brief tour of the home was undertaken and many improvements noted although the manager was advised to document when the improvements had been undertaken on a programme of routine maintenance and renewal of the fabric and redecoration of the premises. Visitors of a person we ‘case tracked’ considered the bedroom and furnishings provided are appropriate to the person needs. The home was generally found clean at the time of this unannounced inspection and free from odours. Domestic staff are employed to help maintain a clean and safe environment for people living at the home and staff were seen to wear personal protective clothing as and when required. Products hazardous to health are appropriately stored and new data assessments have been obtained for all substances used and made accessible to staff. Laundry facilities are situated to the rear of the property and found satisfactory. The home sought appropriate advice from the Health Protection Agency in relation to one individual. They have also obtained information from the Health Protection Agency on Infection Control procedures in Nursing Homes, which is made readily available to staff working at the home. More than half of the staff team have received training on infection control procedures as recommended by the previous inspection and further dates have been arranged for more staff to attend to ensure there are good infection control procedures in the home. We noted a compliment recorded in the homes complaints concerns and complement book, it was from a relative who wanted to thank the manager and say how pleased he is with the laundry service in the home. He asked that his compliment be passed to the laundry assistant. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 20 Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 21 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 good Staff work positively with the people they support and are provided with improved training opportunities to ensure they are fully equipped to meet the individual needs of the people living at Abbeyrose. Resident’s have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs six qualified nurses. Seven of the eighteen care assistants hold a recognised care award known as a National Vocational Qualification at level 2 and above. It was reported that the home is fully staffed and records seen evidence a reduction in the use of agency staff thus providing a greater continuity of care for the people living at the home. This was recommended at our previous inspection and improvements in the reduction of agency staff was acknowledged through surveys received by the home as part of their quality assurance processes. The staff rota examined reflected the staff on duty at the time of the inspection which consisted of one registered manager, one Care Co-ordinator, one qualified nurse, five care assistants, one chef, a kitchen assistant, one laundry assistant and one domestic to support twenty six service users Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 22 currently accommodated. The number of care assistants on duty of an afternoon reduces to four. Staff spoken with shared concerns in relation to the supervision of people in the main lounge when they are undertaking personal care duties and supporting people retiring to bed. This was fully acknowledged by the manager and Care Co-ordinator who agreed to review this. We looked at the recruitment files of three new staff employed since our last inspection and these contained the majority of the information required with the exception of a photograph for the two most recently employed staff and only one reference was available for one member of staff instead of two. The manager stated that he had received the reference but was unable to locate it at inspection and agreed to address these minor shortfalls at the earliest opportunity to ensure people are not placed at risk of harm. The manager reported that all new staff employed use the induction pack provided by the Birmingham Care Development Agency (BCDA) as seen during the inspection which assists newly recruited staff gain knowledge to work safely and effectively and equips them to meet the assessed needs of the people in their care. Staff spoken with reported that opportunities for training are much improved and that they now receive the specialist training for example, dementia awareness and training in safe working practices such as first aid, health and safety, infection control and manual handling. Staff spoken with considered the training has equipped them with the knowledge to meet the individual needs of the people living at the home. Training is provided through an external training provider and the home now has a rolling programme of training readily available for staff. Eighteen staff have now received training in dementia care. Seven staff have recently received training in the management of continence and two in diabetes. One member of staff said “I have definitely seen an improvement in the standard of care delivered, staff now communicate and work well and the morale is much improved. I have done lots of training since the last inspection”. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36 and 38 Quality in this outcome area is good People have confidence in Abbeyrose because it is now led and managed effectively in the best interests of the people living there. The environment is safe for people and staff because appropriate health and safety practices are now carried out, which ensures the safety of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home is a qualified nurse and has completed the Registered Manager’s Award as required in addition to other courses relevant to his role. Staff spoke very highly about how the service is managed Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 24 and the improvements that have been made to provide better outcomes for the people living at the home. Comments include: “The manager is wonderful, open and approachable and is prepared to help us out on the shop floor” “Steven helps out a lot, he is very approachable and everything here has really improved since the last inspection” The manager continues to be supported by a Care Co-ordinator who works part time and her role is to provide support to the manager and staff team for example ensuring staff receive formal supervision at the required time and developing care plans. This arrangement appears to be working well and the staff spoken with feel well supported by the management team. The Manager is more readily accessible now that the office is based on the ground floor, which was also acknowledged in feedback received through surveys completed by health and social care personnel as part of the homes quality assurance procedures. Since the last inspection surveys have been distributed to people who use the service, relatives, health and social care professionals and staff in order to gain their views abut the quality of care provided at the home. The report of the findings was reviewed and indicated that home received a good response. Comments include: ‘The manager and care co-ordinator work and visit more often on weekends, as well as unannounced visits to monitor the care given over this time’ ‘Agency staff have not been employed for the last three months’ ‘The long wait to gain access to the home has ceased as manager/nurses office is now located on the ground floor next to main door therefore staff/managers more accessible to visitors’ ‘Staff clinical knowledge is improving due to improved training opportunities such as dementia awareness and continence management. ‘Induction and training has improved’ ‘Staff formal supervision now provided at required frequency 6 – 8 wks’ ‘Communication improved with staff handover between shifts…’ Discussions with service users, staff and visitors indicate that people living at Abbey Rose were consulted with about improvements to their home for example people were involved in choice of colour for their bedrooms and communal areas and colour samples were obtained to assist people with their choice. The home welcomes suggestions for improvement and as stated earlier a ‘suggestion box’ is made available in the reception area. People who use the service and their relatives are also welcome to attend a residents meeting to share their views and made welcome to attend events arranged by the home. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 25 A number of internal audits have been completed since the last inspection to include equipment, the laundry, sharps, house keeping and the kitchen. We made it a requirement at the previous inspection for reports of monthly visits to the home to be made available to ensure the Provider is monitoring that the home is being run in the best interests of people who live there. Although it was reported that the owner visits the home on a regular basis no reports were available for inspection as required. Following the inspection we received notification from the manager that the Finance and Operations Manager will now carry out the visits and complete a report on his findings and make these available to us. These reports should help inform future planning and outcomes for people living at the home. The arrangements for the management of service users’ personal money was discussed with the manager who reported that the home invoice for extras such as hairdressing, chiropody, newspapers etc. However monies are currently being held for one person on a temporary basis while Social Services are dealing with the transfer of receivership to them. Although some measures are in place to safeguard the resident and the manager, the agreement to hold monies had not been recorded in the person’s care plan. There were no written guidelines for how he should be supported to access his own money. The manager fully acknowledged this and following the inspection told us that he had spoken with the person’s Social Worker and have since drawn up a care plan detailing where his money is and how staff should help the resident to access his money when he requires anything. Minutes of staff meetings held since the last inspection were readily available and staff spoken with reported that they are now in receipt of formal supervision on a more regular basis to discuss progress, performance, training and philosophy of care and provide support and guidance for staff. The Care Co-ordinator reported that they are working towards the required frequency. Individual performance reviews with staff have yet to be undertaken but discussions with the Care Co-ordinator indicated these will be done with all staff at the earliest opportunity. Health and safety procedures appeared satisfactory at the time of this inspection. Certificates for the servicing of equipment are maintained and safety checks are undertaken at the required frequency. The staff-training matrix identified that the majority of staff have undertaken training in safe working practices such as manual handling, infection control, fire and that training in food hygiene was due to take place very shortly. Risk assessments for safe working practices were available with evidence of review. Concerns were identified at the previous inspection in relation to inappropriate manual handling techniques used by staff, which placed people at risk of injury. Following the inspection appropriate training was sought and twenty- four staff have now received training in manual handling. Staff were observed using appropriate and safe manual handling techniques during the inspection. Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 26 Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 27 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations The number of care assistants available on the late shift should be reviewed to ensure there are enough staff available to meet the assessed needs of service users, the size and layout of the home. Reports of monthly visits to the home should be available to ensure the Provider is monitoring that the home is being run in the best interests of people who live there. 2 OP33 Abbeyrose Nursing Home DS0000061145.V368004.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V368004.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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