CARE HOMES FOR OLDER PEOPLE
Abbeywood House Cary Park Babbacombe Torquay TQ1 3NH Lead Inspector
Peter Wood Unannounced 11 August 2005
th 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 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. Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Abbeywood House Address Abbeywood House, Cary Park, Babbacombe, Torquay, Devon, TQ1 3NH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 313909 01803 313925 Mr Clifford Derek Strange Mrs Phillipa Wanda Strange Mrs Anne Long Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 08/12/04 Brief Description of the Service: Abbeywood House is now registered to provide accommodation and care for a maximum of thirty people who are elderly and who may have physical disabilities and/or dementia further to the completion of a ten bed extension. The home is situated in a quiet residential area and overlooks Cary Park. Shops, churches and other local amenities are within walking distance. The home is very well presented and all of the rooms seen were well decorated, comfortably furnished and clean. The home has sufficient adaptations and equipment to assist those with physical difficulties. Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a weekday in August 2005, with a second brief visit some days later. As is often the case with unannounced inspections, neither the owners nor the manager were at the home at the time of these visits. The manager was undertaking a course held by the local team for mental health in elderly persons. It was therefore not possible to address with either the owners or manager the sixteen requirements and seven recommendations made at the last inspection, nor the additional fifteen requirements and three recommendations subsequently made by the pharmacist inspector. The home’s improved medication practices were, however, examined, and correspondence entered into regarding the requirements and recommendations, some of which had been made at earlier inspections. The owner’s response was not received until 9 November 2005, hence the delay in writing this report. A complete tour of the recently enlarged home was undertaken. The main focus of the inspection was consulting residents about their views of living at this home. All residents who were able to give an opinion were consulted, as were three sets of visiting relatives. Opportunity was taken to consult with staff on duty, particularly the two very able seniors who assisted throughout the inspection. What the service does well: What has improved since the last inspection?
Several requirements raised in the last report have been satisfied: The Statement of Purpose has been amended but requires further amendment. The Service Users’ Guide has been amended but requires further amendment and residents given copies.
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 6 Risk assessments are now carried out and risk management strategies are in place. All accidents that result in a service user requiring medical attention are now reported to the Commission. The home now has a new medication administration system and staff receive appropriate training. The home now has a safe outdoor area to enable all of the service to use the gardens. Residents are being given a lockable facility within their rooms and locks are being fitted to bedroom doors in priority order. The registered person is seeking advice regarding covers for hot water pipes and radiators to reduce the risk of scalding. The registered person has re-painted the laundry floor and walls to ensure that they can be easily cleaned. New staff now receive induction training. Questionnaires have been devised and are currently being implemented to seek the views of residents and others. A fire risk assessment of the premises, staff training and keeping records of fire alarm and escape lighting testing has been completed. Several recommendations raised in the last report have been satisfied: An approved Accident Report Book is now used to record accidents to staff and service users. Advice is currently being taken regarding an assessment of the premises by a suitably qualified occupational therapist. Design solutions are currently being put in place to ensure that water is stored at a safe temperature. Staff are now provided with a statement of terms and conditions of their employment and copies of the GSCC Code of Conduct. Care staff now receive formal supervision at least six times a year to cover all aspects of practice, the philosophy of care in the home and career development needs. What they could do better:
Several requirements and recommendations made at previous inspections remain outstanding. Most of these have been addressed to some extent and the owner has agreed that full compliance will be achieved by 30 November
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 7 2005. Outstanding items include further amendment to the Statement of Purpose; the development of policies, procedures and staff training in abuse issues; and provision of locks and expert advice regarding hot water control. 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. Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 6 Good systems for admission allow prospective residents and their relatives to be confident that their needs can be met. EVIDENCE: The admissions procedures ensure that prospective service users will only be offered a place at the home if their needs can be met. The recently registered manager would normally undertake a pre-assessment prior to a resident’s admission, followed by a more detailed assessment that generates a reasonably comprehensive care plan. Prospective service users will be invited to visit the home before making a decision to move in on a trial basis. Visiting relatives said that they chose this home over others they also visited because of the attractiveness of the building and the friendliness of the staff. They confirmed that their relative residents received very good care and were happy with their choice of home. Residents who were able to give an opinion praised the kindness and capabilities of the staff, who are, for example, capable of helping them in and out of bed, wheelchair etc without hurting them. The home does not offer intermediate care.
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Service users health, personal and social care needs are being met and service users are treated respectfully. The home’s improved practices relating to medication administration now protect the service users from risk. EVIDENCE: Discussions with staff, residents and relatives evidenced that residents’ health, social and personal care needs are properly assessed, monitored and met. Referrals are made to health care professionals where necessary. The home’s system of medication administration has changed following the visit by the pharmacist inspector. That pharmacist’s inspection resulted in a further fifteen requirements and three recommendations. In the light of the absence of the owner and manager this long list was not checked off, though the current system was examined and found to be mostly satisfactory. The home has now changed supplying pharmacist and type of monitored dosage system, which the staff member administering medication seemed to understand and operate mostly properly, though medication just given had not been signed for. Observation of staff evidenced that residents are treated with respect and their privacy and dignity is maintained, for example staff always knock on bedroom doors and await a response before going in.
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 Social activities are provided which gives interest for the service users. Residents maintain contact with their friends and families and are encouraged to exercise as much choice and control over their lives as possible. EVIDENCE: The routines of daily living are flexible and the residents’ right to choose when to go to bed and get up are respected. Social, recreational and occupational activities are arranged by the staff and by professional entertainers. An activities person was visiting the home at the time of this unannounced inspection, which residents seemed to enjoy. Some residents said they would like more activities. Those with relatives who lived locally enjoyed being visited and taken out by them, while some others said they would like to be taken out by staff more often than they were. Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Complaints and suggestions from service users, relatives or other visitors to the home, are treated seriously. Service users are listened to and issues resolved promptly. EVIDENCE: According to residents who were able to voice an opinion and relatives who were visiting the home at the time of the inspection any suggestions or complaints they may have are resolved satisfactorily without recourse to a formal complaints system. The home does have a complaints procedure and a record book for recording complaints, but those consulted were not aware of it. According to the previous regulation inspector information is provided to enable the service users to contact Advocacy Services if they wish to do so, though those consulted were not aware of it. Staff training is needed on the issue of abuse and protection of vulnerable adults. Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, 25, 26 The service users live in a very pleasant, well-maintained home that is comfortable and warm and which provides sufficient facilities to meet their needs. EVIDENCE: Abbeywood is a large detached property close to all local facilities opposite a public park in the Babbacombe area of Torquay. The home benefits from a new ten bed extension which matches the existing property very well. The home’s attractive grounds which includes a very pleasant patio area with a fountain have also been made safe as the garden gate can be opened by means of a keypad. The home is well presented, comfortably furnished and clean. All but two of the residents’ bed-sitting rooms are single rooms and all but two of these have en-suite toilet facilities. Resident’s rooms reflected their personality. Some residents proudly showed me their rooms, some of which contained items of their own furniture as well as smaller personal items. The heating, lighting and ventilation are satisfactory.
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 Residents are cared for by motivated staff in sufficient numbers to meet the needs of those currently living in the home. EVIDENCE: The staffing levels appeared adequate on the day of inspection to meet the needs of the residents. Staff observed appeared experienced in the provision of care to elderly people, were patient and treated the residents with respect. Residents and visiting relatives confirmed this observation: “I feel safe leaving my mother here” said a relative, while several residents praised the staff with the same theme: “the girls are lovely and kind”. Some staff proudly wore their NVQ badges and there appears to be a culture of training in this home, though the extent of this was not verified with the owners or manager in their absence. Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 37, 38 Residents live in home which is run in their best interests. The owners, manager and staff team strive to provide a stimulating, safe environment that respects and protects service users’ rights. EVIDENCE: Since the last inspection the owners have appointed a manager who has recently been registered with the Commission. However, discussions with both an owner and the manager reveal a lack of clarity regarding each other’s role, in particular the responsibility to produce and maintain policies, procedures and records. Such paperwork is considered a much lower priority than providing care. Observation indicates that care provided is of a high standard, though it has taken the owner considerable time, in some cases over a year, to address requirements and recommendations, most of which relate to paperwork.
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 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 x
COMPLAINTS AND PROTECTION 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 3 x x x 2 3 Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 17 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4&5 Regulation OP1 Requirement The registered persons must amend the Statement of Purpose to include details of the fire precautions and associated emergency procedures and the arrangements made for dealing with reviews of service user’s care plans. The registered persons must also amend the Service Users’ Guides to include details on how to contact Social Services and the Health Authority, and individual statements or terms and conditions and/or a standard form of contract between the home and each of the service users. The service users must be given copies of their individualised Service Users’ Guides and revised copies of both documents must be sent to the Commission. This requirement is outstanding from the last inspection report and the deadline has been extended from 10/8/04. The registered persons must include the statement of terms and conditions in the Service Users’ Guides. The statement of
D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Timescale for action 30/11/05 2. 4&6 OP2 30/11/05 Abbeywood House Version 1.40 Page 18 3. 12, 13, 18 OP18 4. 23 OP19 5. 23 OP25 terms and conditions must be amended to include details of the communal space that the service users have access to. This requirement is outstanding from the last inspection report and the deadline has been extended from 10/8/04. The registered persons must 30/11/05 provide training to raise the staff’s awareness of what constitutes abuse and develop policies and procedures, in line with Public Interests Disclosure Act 1998 and the Department of Health Guidance ‘No Secrets’, to ensure that the staff know how suspicions or incidents of abuse should be dealt with. This requirement is outstanding from the previous inspection report and the deadline has been extended from 10/9/04. The registered persons must 30/11/05 provide each of the service users with a lockable facility within their rooms and give the service users the keys to their lockable facility unless it can be demonstrated through a risk assessment that it would not be safe to do so. Suitable locks, which can be overridden in the event of an emergency, must be fitted to the service users bedsitting room doors. This requirement is outstanding from the last inspection report and the deadline has been extended from 23/1004. 30/11/05 The registered person must provide covers for hot water pipes and radiators to reduce the risk of scalding. This requirement is outstanding from the last inspection report and the deadline has been extended from 10/8/04.
Version 1.40 Page 19 Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc 6. 4&5 OP 37 The registered persons must 30/11/05 review the statement or purpose and the service user’s guide to ensure that they contain all of the required information. This requirement is outstanding from the last inspection report and the deadline has been extended from 10/8/04. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 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 OP22 Good Practice Recommendations An assessment should be carried out of the premises, including the gardens, and facilities by suitably qualified persons, including an occupational therapist, with specialist knowledge of the needs of people who are elderly, people with physical disabilities and people with dementia. Provide written confirmation that the requirements of the Water Supply (Water Fittings) Regulations 1999 are being complied with. Design solutions must be in place to ensure that water is stored at a temperature of at least 60 degrees C and provided close to 43 degrees C. 2. OP25, 26, 38 3. 4. 5. 6. 7.
Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 20 Abbeywood House D54-D07 S18311 Abbeywood V226664 110805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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