Inspection on 16/07/07 for Abbeywell Court Mental Nursing Home

This inspection was carried out on 16th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Abbeywell Court Mental Nursing... 08/11/06

Abbeywell Court Mental Nursing... 18/01/06

Abbeywell Court Mental Nursing... 25/08/05

Abbeywell Court Mental Nursing... 02/02/05

Abbeywell Court Mental Nursing... 02/11/04

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

CARE HOMES FOR OLDER PEOPLE Abbeywell Court Mental Nursing Home Dragon Square Chesterton Newcastle Staffordshire ST5 7HL Lead Inspector Mr Keith Jones Unannounced Inspection 16th July 2007 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 Abbeywell Court Mental Nursing Home DS0000026932.V335417.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. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeywell Court Mental Nursing Home Address Dragon Square Chesterton Newcastle Staffordshire ST5 7HL 01782 561769 01782 563102 abbeywellcourt@aol.com 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) Abbeywell Care Limited Mr Paul Hudson Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30) Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3 DE Minimum age 50 years 3 MD Minimum age 50 years Date of last inspection 8th November 2006 Brief Description of the Service: Abbeywell Court provides nursing care for up to thirty older people with dementia care needs and mental health problems. The home is a two-storey purpose built building situated within Chesterton village, Newcastle-underLyme. The home has twenty eight pleasantly furnished and decorated bedrooms between the two floors consisting of twenty six single and two shared rooms. All of the bedrooms have en-suite facilities consisting of a toilet and washbasin. There is a lounge, dining room, small kitchenette and appropriately adapted toilet and bathing facilities to each floor. The central kitchen and laundry is situated on the ground floor. A passenger lift provides access between floors. Externally there is a car park and enclosed gardens. Local shops and facilities are close by and the home is within walking distance of bus routes. The fees charged by the home range from £443.00 to £870.00. Extra charges are made for hairdressing, newspapers, toiletries and clothes. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted with the Registered Care Manager and senior nursing staff. The last inspection report was discussed, and it was noted that there were no outstanding requirements or recommendations. The tour of the home was carried out in a relaxed, courteous and professional manner, everyone concerned expressed confidence in the atmosphere, liking it to a family feeling. There were 28 residents on the day of inspection, with enduring mental health needs (elderly). Three residents were case tracked, which confirmed the establishment of a well run, comfortable and ‘homely’ establishment. The CSCI received a completed Pre-Inspection Questionnaire from the Manager of the home, 4 comment cards from relatives, 1 from the GP and 1 from a member of staff, all complimentary. Relatives who were present were complimentary of the family approach to care, the freedom they enjoyed and the involvement that the manager and his staff encouraged. Everyone appeared comfortable and at ease with their surroundings. A sample review of the administration confirmed solid practice and effective management. Discussions with residents and staff over the general standards of care and service proved to be enlightening and very constructive. A full report was offered at the end of the inspection with open discussion with the Registered Care Manager. Overall the attitude in meeting caring and organisational demands is highly commendable, with forward thinking, planning and application, contributing to a good quality service. What the service does well: Abbeywell offers a high standard of care and service, is well organised, with a committed care management team. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly individual approach to meeting personal and health care needs. Assessment procedures and care planning is of an excellent standard, offering detailed information on each resident’s progress in the meeting of objectives. The housekeeping and support services all contribute to the team approach, and are recognised by the management and the Inspector for the services observed. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 6 Maintenance of good staffing levels, staff training and clinical supervision are well established in safeguarding the interests of residents. What has improved since the last inspection? 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. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The quality in this outcome area is good. This judgement is based on the examination of the homes policies, procedures, practices and discussions with management. The Home ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. It is recognised that the formal Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live, through the Service User Guide. Following an assessment the senior/nurse assessor determines the suitability of the application in view of the facilities available, and of the capacity of the home, to manage the individual and any special needs. The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose/guidelines reflects an expression of philosophy, and has been well established in representing the foundation on which the home operates upon. It presents an excellent description of the home’s aims and objectives, philosophy of care and terms and conditions. All the requirements prescribed in Schedule 1 are addressed, with an additional pictorial presentation, which would be enhanced with larger print. The contract document reflects changed circumstances and conditions, including an identification of allocated bedroom agreed. The care manager adheres to a strict admission policy of personal supervision of the pre-admission assessment. Case tracking of three resident’s files demonstrated the presentation of a highly personal approach to prospective residents and their relatives on pre-admission. A detailed assessment was examined and found to collect a full profile of physical and psychological needs, as well as social, cultural and environmental circumstances. An appraisal is made, and discussed, to ensure the home can satisfactorily meet those needs. Case tracking and discussion with some residents and staff confirmed that this standard is well met. Following an assessment the senior carer assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Case tracking confirmed that a valuable exchange between resident and assessor took place and resources made available. These resources were seen to be a deployment of staffing skills, equipment and general environment. Prospective residents and their relatives are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. The management style is highly personable and inclusive, generating a warmth and comfortable environment. Relatives are welcome to view the facilities and participate in the planning and assessment of care. On the day a relative of a prospective resident was viewing facilities and discussing care arrangements with staff. She was impressed with what she had observed and expressed her wish to engage the Home. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 10 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 and 11 The quality in this outcome area is good. This judgement is based on the examination of care plans, discussions with residents, staff, managers, general observations and the Home’s medication system. The service users’ assessment provides the base from which care planning is formulated. It is recognised that this reflects an individual profile of needs, discussed fully with family. The home has a GP provision that visits the home frequently. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. There exists a straightforward, yet effective medicines administration system, accurately monitored and actioned on two floors. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three case records were examined, and found to offer a clear, well balanced, up to date and accurate appraisal of requirements. Reviews were done on a minimum of once a month, usually more often, as needs dictate. Case tracking of those residents confirmed the depth of risk assessed care planning, supported by a solid foundation of organisation and quality services. The system would benefit with a clear record of review with family, and ownership of records by staff. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon a personal profile, risk assessment and evaluation of their strengths, to be implemented and frequently reviewed. That review is more frequent, dependant upon the individual’s needs and clinical condition. A process of evaluating low, medium and high risk factors that affect personal potential (strengths) was seen to offer a sophisticated, yet effective facility in focussing attention and resources. A daily report evidenced progress and response, offering a valuable chronicle of care. A tour of the premises evidenced that there was a range of pressure relieving equipment, and examination of service user plans found that all are assessed in relation to pressure sore risk, falls risk and nutritional risk, with monthly observational checks recorded. There were over twenty variable height beds available, two electrically driven. The administration of medicines adhered to procedures to maximise protection to service users. The storage was secure with satisfactory added security for controlled drugs. A controlled drug register was examined and found to be in order. There were no residents accommodated in the home at the time of the visit who were able to self medicate due to their limited cognitive abilities. Family and friends have relative freedom of visiting, those spoken to remarking on the importance of maintaining social contact. The Statement of Purpose clearly and openly states that the wishes concerning arrangements after death would be discussed and respectfully carried out, ascertained as soon as possible after admission. A very sensitive end-of-life understanding, arranged with involvement of the Alzheimer society, North Staffs NHS PCT, the University Hospital NHS Trust, and local GP and nursing staff, with full awareness of families, was effectively deployed. The spiritual needs of service users were recorded and observed by the staff with due respect. A regular interdenominational church service is established. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 12 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 The quality in this outcome area is good. This judgement is based on discussions with residents, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. Abbeywell’s main objective is to respect the individual, thus delivering care in a relaxed and easy environment, with routine flexible to accommodate needs, and not dictate daily life of service users. Personal choice and relative selfdetermination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. These policies are designed to match expectations and to achieve a harmonious relationship throughout. Activities were in evidence on the inspection day and a programme of in-house entertainment was available. Choices were available for every aspect of daily living and menus provided a varied and good choice of food available on a four weekly programme. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of residents. Service users’ life-styles and interests are recorded in their care plan, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Personal choice and relative self-determination are respected in policy and action. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 13 EVIDENCE: The Home has a major objective in respecting the individual, delivering care in a relaxed and easy environment, with routine flexible to accommodate needs, and not dictate daily life of service users. The Statement of Purpose/Guide indicate a flexible routine, established to meet the preferences of service users. The daily routine was seen to be flexible and non-institutionalised, offering choice for meal times, personal and social activities. Discussions with service users and staff clearly identified a relaxed and informal atmosphere in which the service user’s needs were paramount, with the security that there are familiar events to the day they could relate to. An activity co-ordinator and assistant have a high profile in contributing to the care planning process, and is clearly well accepted by residents and staff alike. The recording of social activities was seen to be an integral part of care reporting and planning. There is a positive cognitive stimulation therapy programme, with sessions organised to stimulate and engage people with dementia. At the time of inspection a sensory, ‘mobile Snoozelan’ session was in progress, with an impressive participation and response from residents. The Home operates an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. One relative comment card response was appreciative and complementary of the policy, especially at the early days following admission. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Those service users’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. If anyone who is able wishes to handle their finances, or self-medicate, they do so, otherwise family are usually prepared to take responsibility for money matters. No service user wanted to take up that option at the time of inspection. The care manager emphasised that the strength of protecting service user’s rights was secured through the robustness of the procedures in place. This was confirmed on examination of records. Advocacy procedures and services are available to those who require them. Abbeywell offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied and excellent choice, to which the cook emphasised, was consumer led, often well opinionated. Lunch was served during the inspection and found to be an attractive and well-presented meal. Special diets were accommodated with the cook making every effort to engage Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 14 with service users to discuss personal preferences. Staff were seen to offer discreet assistance to those who required it. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. The manager was advised to have available a protective coat at the kitchen door. A cleaning schedule was in place, and the kitchen was seen to be clean, well equipped and kept in good preparation. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 15 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): 16,17 and 18 The quality in this outcome area is good. This judgment is based on the examination of the homes complaint procedure, handling of allegations of abuse and the recruitment procedure of staff to ensure the protection of service users. The Home had a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The new arrangements for handling complaints in the spirit of Inspection for Better Lives were understood. Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their position in protecting service users from abuse, of all natures. EVIDENCE: Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 16 The complaints policy was seen and records examined. There were few minor complaints assessed, all dealt with at the source. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The CSCI had not received any complaints since the last inspection. Case tracking confirmed the effectiveness of a Care Manager and staff sensitive to service users needs and readiness to test the robustness of their information and report structures. As part of the process of encouraging selfdetermination a policy exists to be able to offer advocacy services should they be required. Family involvement has been the usual means of representation in the past. Residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. This process was evidenced on examination, and case tracking as previously reported upon. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. It was acknowledged that abuse is established as a regular feature on the annual training programme for all staff. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 17 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 - 26 The quality in this outcome area is good. This judgement was based on discussions with residents, staff and a tour of the premises. The building has been well maintained, having had continual attention to refurbishment and an ongoing upgrading programme. The interior state of general repair is at a good standard; bedrooms are well appointed, of a satisfactory size. Communal areas are furnished and decorated to a satisfactory standard to present a comfortable environment. Service users live in a safe and well-maintained environment with a planned preventative programme designed to sustain the good standards. Each of the bedrooms provided a satisfactory level of furnishing and facilities to which each resident has been encouraged to add their personal belongings, furniture and décor as the wished. The standard and presentation of all the toilets and bathrooms were of a good quality, clean, uncluttered and odour-free. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 18 EVIDENCE: The location of Abbeywell is conducive for a care home, situated in an urban setting with good access to road links, and a short drive to Newcastle town. External car parking and grounds are spacious and well maintained. The fenced rear garden offers a pleasant area for fresh air and reflection, although the garden needs weeding and tending to. It is recognised that a 10-bedded extension is planned for this year, which will necessitate alternative use of external space. The garden to the side was overgrown and had hazardous old equipment and furniture that needs removal. Nevertheless the external state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. Interior state of repair is at a good standard; bedrooms are well appointed, of a good size and accessible. The refurbishment and re-decoration programme is a constant feature, with rooms refurbished on vacancy. It was recognised that a major refurbishment of bedroom furniture has been completed, and that a separate programme of renovation has been funded, from that of the extension. The management are advised to make formal application to CSCI on approval of the plans by the Borough Council. The care manager will arrange for a full unit risk assessment appraisal to be undertaken by the next inspection. Bedrooms were well maintained to meet service user’s personal preferences. There are some 20 variable height beds available. Individual assessment ensures the special needs of service users are accommodated. Evidence was seen of well-maintained movement and handling equipment, supported with written policies and procedures, and regular training sessions. The Care Manager expressed a willingness to meet any reasonable demand for special needs. Most bedrooms had been decorated and furnished to meet individual preferences. Personalisation was enhanced with own furniture and personal belongings. The outcome is a comfortable and familiar private domain that reflects the service user’s preferences. All bedrooms are en-suite. Fire protection facilities are in place, and assessed by the Care Manager on a regular basis in his capacity as recognised fire officer. Refurbishment is a continual process and when a room comes vacant the opportunity is taken to address décor and general accommodation facilities. Each service user has a lockable facility in their own room, and have the choice to hold the key. All bedroom windows are secure with restrictors, over-bed lights and a smoke alarm. An effective nurse call system is installed and well maintained. It was advised that oxygen supplies be kept in the treatment room. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 19 The lounge areas provide comfortable, odour free and a popular centres for socialising and relaxation. The furnishings are of a good quality compatible with the needs of the elderly. The areas offer options, whether to either socialise or seek a little peace and quiet. Each room is adjacent to the dining rooms with available screening to isolate during social or therapeutic sessions. The ‘Blue room’ doubles up as the activity coordinator’s base. The activity coordinator ensures a programme of events and meaningful diversions, in which social activities have a direct influence in the care reporting and evaluation The dining areas offer clean and pleasant environments. For those who prefer to eat alone can do so in the lounge or their own rooms. Staff were seen in attendance, providing social diversion, forms of occupational therapy and attentive nursing care. The standard and presentation of all the toilets and bathrooms were of a good quality, clean and odour-free. Two bathrooms are not effectively utilised affecting the provision ratio for adequate numbers of assisted baths. Plans for shower conversion and upgrade of equipment are recognised within the plans for extension. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. Toilets are accessible to all and within close proximity to all communal areas. There are two sluice facilities, each having suitable arrangements to meet requirements, although neither are used due to toilet arrangements elsewhere. Notices regarding chemical handling in the areas that store chemicals displayed appropriate COSHH posters and information charts. The heating arrangements throughout the home are by central heating with guarded radiator convection. Lighting facilities, including individual bed lights and overall emergency lighting are regularly maintained by the handyman. Water temperature were randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm. Ventilation is by direct door and window airing. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the home. Communal areas were equally well served with utilities. Servicing records were examined and found to be up to date and accurate. An awareness of health and safety issues was high on training and supervision priorities. The standard of cleanliness was seen to be excellent throughout, with no offensive odours in any of the rooms inspected. Sluices, bathrooms and toilets were cleaned on a routine basis presenting a hygienic environment. The laundry was well organised and equipped to a good standard. COSHH regulations were displayed and relevant to solutions in use. Infection control Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 20 was efficiently organised from frequent and regular appraisal of cross infection procedures. Abbeywell Court Mental Nursing Home DS0000026932.V335417.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 The quality in this outcome area is adequate This judgement was based on the examination of staff files, working rotas, training and supervision programmes, and discussions with staff. Staffing stability has been maintained with consistent levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving experienced staff. Agency and Bank staff are rarely used, with agreed overtime and flexible rostering accommodating shortfalls. The management have an inconsistent procedure for interview, selection and appointment of staff. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of service users. All staff receive training in care issues within the home from registered nurses and external trainers. Training and supervision records need to demonstrate the observed high standards of training taking place. EVIDENCE: Duty rotas were made available, and inspected, with staffing levels seen to be satisfactory. The overall general skill mix and numbers of staff working in the Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 22 home meet the needs of up to 30 service users. There was a proportionally high trained Nurse representation on each shift, with the Care Manager supernumerary, although contributing to shifts on occasions. The daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. Agency coverage has been infrequently used since the last inspection; overtime and flexible rostering meet shortfalls. An average daily coverage was recognised based on 30 nursing service users. a.m - 2 RN 6 carers p.m - 1 RN 5 carers N.d - 1 RN 2 carers Arrangements with Medical and Nursing Schools provided regular placements. Local schools send 16 year-olds for work experience placement. The catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of the residents. There is a full time administrator, a 20-hour handyman/gardener, and an activity organiser with an assistant working 32 hours a week. The Care Manager emphasised the home’s commitment to training and to achieving targets for NVQ level 2. There are 13 staff with NVQ level II and level III, representing a 50 achievement. There are10 certificated firstaiders, and 8 Registered Nurses on the home’s staffing establishment. Four staff files were sampled and found to be inconsistent in the process of appointing staff. It was evidenced that POVA and CRB checks have been made. It was noted that each file omitted some of the procedure. The Care Manager is required to ensure adherence to a structured approach to maximise safeguards to residents. Three on-duty members of staff were interviewed, each expressing their working conditions openly and with confidence. Each individual was complementary as to the level of training they receive, and the management arrangements. Clinical supervision was seen to complement an effective induction and training programme. Diversity issues with staff were discussed and confidence expressed as being recognised and accommodated. A student Nurse on her second assignment was interviewed, being keen to express her appreciation of the high standards of practice and management she had met at Abbeywell. Evidence showed attention to a supervised training involving a shared aspect of responsibility between staff and trainer. Training plans drawn up were examined and found to offer a meaningful commitment to the educational, Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 23 supervision and appraisal process. Mandatory training was seen to be complied with, which was complemented with dementia care, palliative care, subcutaneous fluid administration, CPR, and wound management. Awareness of the soon-to-be-introduced Mental Capacity Act sessions have been completed. Staff indicated a degree of supervision based mainly on clinical issues, and a high degree of sensitive support from management on personal events. However the individual records were unable to demonstrate that quality of supervisory management. It was agreed that the Care Manager would undertake a review of the procedure, in the creation of suitable cascaded approach to general supervision for all members of staff. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 24 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good. This judgement was based on discussions with the Registered Manager, trained Nurses, the examination of the home policies and procedures with regards to the effective management of the home, general survey comments, general observations during the process of the inspection, and discussions with residents, visitors and staff. EVIDENCE: The Care Manager Paul Hudson offers a considerable resource of experience and skills, which are reflected in the high standing in which Abbeywell is held by residents, their relatives and the community alike. He holds RMN, RGN and CPN qualifications. The Registered Provider has two Operational Managers who Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 25 regularly review care standards and practice. CSCI would require a monthly Regulation 26 report in the absence of frequent Provider involvement. It is recognised however that the Care Manager feels well supported in operational matters, and influential in determining the short and long-term planning for the Home. Plans to extend the Home with an additional 10 beds are advanced, with the full involvement of Paul in being rationalised to maintain standards. The management have developed a formal approach to monitoring quality across a wide range of activities. This includes care risk assessment, care plan review process that is recorded at least once a month, a staff training programme and an environmental risk assessment prevention programme. This includes the setting of objectives, forward planning on short-term and long-term planning, as evidenced in the arrangements of refurbishment and extension of Abbeywell. Evidence was secured to acknowledge achievements, ongoing and planned objectives. Involved within this process are the views of service users and relatives, confirmed at case tracking, relatives audit and informal discussion. Social Workers’ review meetings are often a vehicle for assessing quality. Staff meetings are held regularly. Care plans were drawn up, implemented and reviewed with residents and relatives whenever possible. Case tracking, and informal discussion provided evidence that participation is encouraged. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. These included procedures on abuse, COSHH control and infection control. Service records for the gas, water, and fire assessments were evidenced. Planned maintenance and risk assessment ensures that essential services linked to utilities and safety, are monitored and serviced on a regular basis, including PAT reports. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training, with the Care Manager recognised as the formal Fire Officer. Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been reported recently. The style of management was seen as by direct observation, and by discussion with residents, relatives and staff, and that a very open and positive attitude prevails, enhancing the home’s ‘family feel’ and homeliness. The additional support offered by the Operational Managers was evident in the maintaining and consistent appraisal of standards. There was strong evidence of openness and honesty in speaking with residents, relatives and staff in which day to day events and episodes were freely discussed. On-site inspections offers evidence of a management firmly in control, well organised and prepared to facilitate Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 26 meaningful, delegated responsibilities to an efficient care management team, sensitive to the needs of service users. Abbeywell Court Mental Nursing Home DS0000026932.V335417.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 3 3 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 2 3 Abbeywell Court Mental Nursing Home DS0000026932.V335417.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. 1 2 Standard OP36 OP29 Regulation 18(2) Schedule 2 26 Schedule 4 Requirement Staff must receive supervision six times a year. You must demonstrate robust recruitment, application and interview procedures within the home. That the Provider submit a Regulation 26 report to CSCI each month. Timescale for action 01/09/07 01/08/07 3 OP31 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP33 OP26 OP19 OP19 Good Practice Recommendations Provide a development plan for 2007/08/09 Access to the kitchen area to have readily accessible overclothing available. That a full unit risk assessment programme be established The registered person shall ensure that the garden area of DS0000026932.V335417.R01.S.doc Version 5.2 Page 29 Abbeywell Court Mental Nursing Home the home is kept in a good state of repair, and free from rubbish. 5 6 7 8 9 OP10 OP38 OP182 OP1 Service users Guide will need to be updated to reflect a more accessible information guide. As a course of good practice COSHH posters should be located in areas where chemicals are stored Discontinue the use of notices and sticky labels in Residents’ bedrooms. That oxygen be kept secure in an appropriate store. That the procedure for identifying and handling abuse be updated. Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 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 Abbeywell Court Mental Nursing Home DS0000026932.V335417.R01.S.doc Version 5.2 Page 31 - 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. 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