Inspection on 21/07/09 for Abbeywood Care Home

This inspection was carried out on 21st July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeywood Care Home 28/08/07

Abbeywood Care Home 05/05/06

Abbeywood Care Home 19/04/05

Abbeywood Care Home 05/10/04

Abbeywood Care Home 20/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Abbeywood Care Home Ribble Road Fleetwood Lancashire FY7 7BX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jacqueline Riley     Date: 2 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Abbeywood Care Home Ribble Road Fleetwood Lancashire FY7 7BX 01253776761 01253776761 tojo1717@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Shanmugam Subbiah care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE The maximum number of service users who can be accommodated is: 28 Date of last inspection Brief description of the care home This home is registered for twenty-eight people in an elderly catagory. It provides nursing care to people who have dementia. It is in Fleetwood and is within easy reach of shops and the promenade. The home is purpose built on two floors and has a passenger lift for those who need it. The home has eight single bedrooms and ten double rooms. There are no en-suite facilities. There is one large lounge/dining area and a separate room for people who smoke. There is also a small external sitting area at the rear of the building that can be used by people who use wheelchairs. The home has a Statement of Purpose and Service User Guide providing information Care Homes for Older People Page 4 of 26 Over 65 0 28 Brief description of the care home about the care provided, and the service available so that people can make an informed choice about moving into the home. A copy of the Service User Guide and the most recent inspection reports is made available to all users of the service to help them to make an informed choice about whether to move into the home. At the time of the visit the range of fees was from £382.00 for residential and £455.00 for nursing care per week with additional expenses for hairdressing, chiropody and toiletries. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The main inspection of Ribble Lodge Nursing Home was undertaken including a visit to the service over a five hour period on 14th July 2009. We spoke to the deputy manager, three staff members, and a visitor. We spent time in and around the communal areas of the home making general observations to get a flavour of how the home operates on a daily basis. As part of the inspection process we talked to people using the service and asked staff about those peoples needs. We also looked at their rooms, care plans, records and daily notes this is called case tracking. We also invite others using the service to pass on their opinions if they wish, however due to the level of dementia some of the comments were limited. We had some responses from questionnaires sent to people who use the service for Care Homes for Older People Page 6 of 26 their views on how they experience the service. Comments were positive and some are included in this report. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of the service. We use this information, in part, to focus upon our inspection activity. We looked at recruitment and training records of two staff members. We walked around the building and watched people living and working in the home to see how everyone supported and talked to each other. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 26 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are admission and assessment procedures in place to ensure the care needs of people are met. Evidence: We looked at the records of three people living at the home. The records were for people living there on a permanent basis. We saw they had assessment details in place from social workers, or healthcare professionals. In addition there is a pre admission assessment carried out by the homes manager when a placement is being made so that any information the manager feels they might need to provide care to the person can be sought. The information showed the home is informed through these assessments of the needs of the person. Staff spoken to said they use this assessment information to determine the level of care the person needs. Comments received said, We try to get as much information as we can before a somebody comes into the home, It can sometimes be difficult to get the information we need quickly, but by doing our own assessment first it helps. Care Homes for Older People Page 11 of 26 Evidence: We saw the home has in place information about the home and what services it provides. This information is given to residents or their families and advocates, so that they know what the home can provide and make an informed decision based upon information they receive. Comments we received told us that people felt they had good information about the home when their relative went to live there. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is taken seriously. Peoples welfare is monitored and their health needs are identified and met. Evidence: The three care planning records we looked at were accurate and up to date. There was good information about individual healthcare needs as well as how those needs are going to be met. Staff we spoke to said the information is clear and they can follow the plans to maintain and support people who live in the home. Comments included, we work well together as a team, and the information we get helps us to provide the care people need, we follow the care plans which tell us all about peoples needs, and how they should be met. The records we looked at show there are risk assessments in place for people, which highlight what the risk is, how it can be managed and what the outcome is for the person. There was evidence of risk assessments and care plans being reviewed on a monthly basis by the manager. In some instances we saw evidence of changes being made as the needs of the person changed, so that staff were able to meet the Care Homes for Older People Page 13 of 26 Evidence: presenting need at the time. By looking closely at the records we found there are links between the home and other healthcare professionals including, doctors, district nurses, and psychologists, so that peoples healthcare and psychological needs are being met. Medication records and observation of practices in administration showed us it is safe. Only trained staff or the manager administers medication. We looked at three records and found them to be complete and up to date. We looked at how the home stores medication and found it to be in a locked purposeful facility, with metal locked cupboards bolted to the wall to ensure the security of medication. However, whilst we saw medication is audited monthly there was no returns book, showing what medication might have been returned to the community pharmacist. We spoke to the manager about this and the importance of being able to audit all medication coming into the home and that which is returned to the pharmacist. The manager agreed this would be addressed with immediate effect. We saw privacy and dignity is respected during the visit by looking at how staff talk to and respond to people. We found staff to be respectful and sensitive to individual needs throughout the inspection. Staff spoken to said, we treat residents with respect at all times, Because of the dementia it can be distressing sometimes and so we make sure their dignity is protected, I treat people just like I wold expect my parents to be treated, in a dignified way. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are arranged to meet peoples needs. Activities are varied so that people have choice. Evidence: We spoke to some of the staff about routines in the home. They said they are flexible and people can get up and go to bed when they choose. However they said most people get up fairly early with at least two people staying in bed until late morning as this is the routine they like. Staff told us people have their own routines and they respect them. Most people we saw stay in the large communal area which is also a dining room. Following recent recommendations for people to use the dining tables more we were told this is now encouraged. We saw some people use the dining tables to eat their lunchtime meal although some choose to eat elsewhere, and some with limited mobility are assited by staff. We saw there is plenty of space in the communal areas for people to use, and a number of people spent time walking around the communal lounges and corridors without any restrictions. Staff were seen to interact well with people living there, talking to them, spending time with them when they were having a drink or eating a meal. The interaction between staff and people living there was seen to be positive at all times during the inspection. Staff told us they like the way they can spend time with people, comments included, we can have a laugh Care Homes for Older People Page 15 of 26 Evidence: together, its good to spend time with the residents, they are all such characters. The lunchtime meal was being prepared and seen to be wholesome and nutritious. We spoke to the chef who has worked at the home for a number of years. They told us they cook everything daily, and make cakes and pastries which are liked by everybody. Comments included, they get really good food, and the cakes are really nice with a cuppa. The chef told us they are informed of a persons nutritional needs when they are admitted to the home, and they cater for medical conditions such as diabetes or any other nutritional need. They told us they know the individual likes and dislikes of people living there so that they can meet their nutritional needs on a daily basis. We saw people living there have their weight monitored on a monthly basis, as a way of monitoring general health. The way the home approaches activities is flexible, in that there are a range of activities including an activity plan, which staff said they tend to carry out in the afternoon, including singing, music and therapy groups. An entertainer visits the home on a monthly basis and those we spoke to said they enjoyed it. There are visiting clergy who take services for people who choose to attend so their spiritual needs are being met. There is a specific activity co ordinator working up to six hours a week to oversee the activity programme. There are no restrictions for visitors to the home, and we spoke to visitors during the time spent doing the inspection. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for recording and responding to complaints are good making sure people feel listened to. Staff have attended safeguarding training for the protection of users of the service. Evidence: We looked at the homes complaints procedure, which is made available to people using the service and their relatives or advocates during the admission process. We were told by staff and by a visitor they are aware of the complaints procedures and how to use them. Comments included, we are made aware of the complaints procedure and how to use it during our induction, Ive never had to make a complaint but would know who to go to if I needed to. There has been one safeguarding investigation since the previous inspection however the allegation was unfounded. We spoke to the manager and staff about how residents are protected. We were told all staff have access to safeguarding adults training in order to ensure people are protected. The files we looked at showed us that staff have attended training in this area. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built and designed to be homely and comfortable, for people who live there. Evidence: We looked around the home, and found to be well laid out and comfortable. There is a large ground floor communal area with an additional small lounge from the main corridor. In addition this is used a a dining room with tables situated around the edge of the room so people can sit together when eating their meals. We found most people use this room. There are a range of chairs here, and people have the choice of where they can sit. We saw some people like to sit together and chat, others like to sit alone. Television was on but was not to loud so that conversation was not disrupted. There is a passenger lift to access the first floor of the home, which assists people with limited mobility. We saw peoples rooms are situated on the ground and first floor of the home. We looked at some of the bedrooms. We found them to be a good size and they had various items of furniture. This helps people to feel comfortable with personal items around them. All rooms had where necessary aids and adaptations to assist with moving and handling, as well as specialist beds for people who needed pressure care. Care Homes for Older People Page 18 of 26 Evidence: We saw there is a maintenance plan in place and a maintenance employee who carries out regular work on the home. Larger maintenance jobs are put forward for agreement at management meetings as this is part of the annual business planning process. The number of toilet and bathing facilities meet the needs of people currently accommodated. We saw there are a range of aids and adaptations including hoists and walking aids to help people move around the home. There are designated domestic and laundry staff for the home who have received training in infection control as have some of the care staff so that the home maintains a hygienic environment. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures in place for recruiting staff, ensuring the safety and protection of people living there. However limited work history information in application forms may be a disadvantage. Training is delivered so that the staff team have the necessary skills to meet peoples needs. Evidence: We looked at how the staff team is utilised to meet the needs of people during the day and nightime periods. We found the home is using a skills mix of staff so that there is always a trained nurse on each shift as well as skilled care staff. We saw there are sufficient numbers of staff to meet the needs of people living there. Staff we spoke to said they were happy with the way they are supported and how they work in the home. Comments included, Many of us have worked together for a long time and work well as part of a team, We have good access to courses and this helps us in our roles. At least 50 of the care staff have achieved a recognised national care qualification with others being enrolled to complete further training. Most records we looked at showed staff have attended dementia training at various levels over time so that the specialist needs of people living at the home can be met. We looked at two staff files. They showed us staff are recruited safely using procedures which take into account information about their skills and competences for the role applied for. Information about them included application records, references Care Homes for Older People Page 20 of 26 Evidence: which have been checked, Criminal Record Bureau (CRB). Protection of Vulnerable Adults (POVA) checks to make sure they are safe to work with people who may be vulnerable. However whilst application forms are in place they only request a five year history. It is essential a full employment history is sought so that the home has a full picture of an applicants work history, with any gaps being explained. In addition there should be evidence of reasons why people have left previous employment so that the home can ,make an informed choice when recruiting staff. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed for the benefit of all users of the service with systems and policies in place for the safety and protection of people living there. Evidence: We saw the manager is running the home on a day to day basis in the best interests of people living there and staff. Comments included, we feel supported by the management team, You can talk to the manager if you need to. We talked to the management team about team meetings and were told they are held as often as possible to encourage staff to contribute to the development of the home. Staff told us it was useful and that whilst not all staff can attend there is usually a good representation. We found that all records and systems in the home are up to date, so that the information is current. Staff were able to follow clear instructions in the records for the health and welfare of people. We saw there is a clear line of management Care Homes for Older People Page 22 of 26 Evidence: responsibility and that staff communicated well with the manager throughout the inspection process. We looked at how peoples money is handled and were shown records which were accurate and up to date. The amounts were checked and found the be correct according to the record. Record were available to demonstrate that regular test and servicing of essential equipment and services are carried out to ensure the systems are safe. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must record any medication returned to the pharmacist on a monthly basis. This will ensure there is an effective audit trail of medicines going out of the home. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 29 Application forms should request a full employment history so that the home identifies a persons skills and abilities for the role. The application form should request applicants provide reasons why they have left previous employment, so the home is aware of any issues. 2 29 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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