CARE HOMES FOR OLDER PEOPLE
Abbeywood House Abbeywood House Cary Park Babbacombe Torquay Devon TQ1 3NH Lead Inspector
Peter Wood Announced Inspection 13 & 14 December 2005 09:30 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 Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Abbeywood House Address Abbeywood House Cary Park Babbacombe Torquay Devon TQ1 3NH 01803 313909 01803 313925 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) TorbayResidentialHomes.com 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 DS0000018311.V257107.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The Manager completes her Registered Manager`s Award and NVQ in Care at Level 4 by October 2006 The Service User who has dementia and is under 65 years of age is able to remain at the home for as long as the care provided is appropriate That an area of garden is made safe and accessible for use by all of the Service Users 11/08/05 Date of last inspection 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 are well decorated, comfortably furnished and clean. The home has sufficient adaptations and equipment to assist those with physical difficulties. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place over two weekdays in December 2005. Both the owner and the registered manager assisted throughout both days of the inspection, a substantial part of which was taken up addressing the sixteen requirements and seven recommendations made at the last inspection. An examination was undertaken of much of the home’s improved documentation and medication practices. A complete tour of the recently enlarged home was undertaken, and all residents who were able to give an opinion were consulted. Opportunity was also taken to consult to a greater or lesser extent with staff on duty. Several comment cards were also received from residents and relatives. What the service does well: What has improved since the last inspection?
Sixteen requirements and seven recommendations were made at the last announced inspection, plus a further fifteen requirements and three recommendations made by the pharmacist inspector. All have now been addressed; some have been met while some action has been undertaken on those that remain outstanding. Requested amendments have now been made to 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. Requested amendments have now been made to the Service Users’ Guide to include details on how to contact Social Services and the Health Authority.
Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 Page 6 Residents are now given an individual statement of terms and conditions / contract. This is included in the Service Users’ Guide. The statement of terms and conditions now includes details of the communal space that the residents have access to. The home now provides training to raise the staff’s awareness of what constitutes abuse and are developing appropriate policies and procedures to ensure that the staff know how suspicions or incidents of abuse should be dealt with. The home now provides suitable locks, which can be overridden in the event of an emergency, to the residents’ bed-sitting room doors. The home now provides each resident who wants one with a lockable facility within their rooms. What they could do better:
Although it is judged that the home meets virtually all the National Minimum Standards in terms of the outcome for residents, which is now the criterion rather than the detail of every element of every standard which was the previous criterion, this inspection revealed that the home could do better in some areas. The registered person must provide covers for hot water pipes and radiators to reduce the risk of scalding. This requirement has been outstanding from previous inspections. The owner seems to regard the recording of complaints to be negative, and so has not done so in about twenty years. However, examples of positive experiences were discussed during the inspection. It is recommended that all expressions of dissatisfaction and the action taken to resolve the situation are recorded. It is recommended that written confirmation is obtained 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. It is recommended that the owner and manager clarify and put in writing their respective roles and responsibilities to ensure effective and efficient management of the home. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 Page 7 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 DS0000018311.V257107.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4, 5, 6 Improved information and good systems for admission allow prospective residents and their relatives to be confident that their needs can be met. EVIDENCE: The home advertises on the internet and now has a good Statement of Purpose and Service User Guide to describe the services offered. 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 are invited to visit the home before making a decision to move in on a trial basis. Each resident now has an appropriate contract. Residents who were able to give an opinion praised the kindness and capabilities of the staff. The home does not offer intermediate care. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 Residents’ health, personal and social care needs are met and they are treated respectfully. The home’s improved practices relating to medication administration now protect the service users from risk. EVIDENCE: Consultations with the owner, manager, staff, residents and relatives and examination of relevant documentation evidenced that residents’ health, social and personal care needs are properly assessed, monitored and met. The home’s system of medication administration has been completely overhauled in the light of pharmacist inspector’s visit following the previous announced inspection. The new system of receipt, checking, storage, administration and recording was witnessed during the inspection. The previously dangerous system can now be commended. Observation of staff evidenced that residents and staff treated each other with mutual respect. Residents’ dignity is maintained by, for example, being presented well, and being addressed as each resident prefers. Resident’s privacy is maintained, an example being that most staff observed knocked on bedroom doors and awaited a response before going in.
Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15 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: Social, recreational and occupational activities are arranged, some by the care staff themselves but mostly by external professional entertainers. Some of these were advertised on the notice board. An activities person was visiting the home at the time of the inspection, which residents seemed to enjoy. Some residents said they would like more activities. One resident said she would like a library trolley to visit this home as at other homes, unaware that the home has arranged for the library services’ mobile library to visit regularly, providing a far greater range of books than any trolley service can provide. 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 DS0000018311.V257107.R01.S.doc Version 5.0 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 the following 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: The home has a complaints procedure prominently displayed and a record book for recording complaints, but this has not been used in about twenty years. One complaint was recently received from the relative of a resident who had left the home many months previously. The owner responded robustly, clearly expressing his resentment to receive what he considered to be an unjustified complaint. According to residents who were able to voice an opinion any suggestions or complaints they may have are resolved satisfactorily without recourse to a formal complaints system. Staff have received training on the issue of abuse and protection of vulnerable adults. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 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, containing items of their own furniture as well as smaller personal items. The heating, lighting and ventilation are satisfactory, though some radiators still need covering to protect residents from burns.
Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 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 confirmed this observation. 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. The owner (himself City and Guilds qualified) and the new registered manager (currently undertaking her NVQ and Registered Managers Award) are very keen to develop staff training, currently a work in progress. Staff are recruited carefully, resulting in a stable staff group. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following 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: The owners recently promoted an existing staff member to the position of manager, who has subsequently become registered with the Commission. Together, they are tackling in their order of priority the many tasks that are required to update the home. The first priority has been the ten-bed extension which has enhanced the facilities of the home. So far, paperwork has been well down the list of priorities. Additionally, there remains a lack of clarity regarding each other’s role, in particular the responsibility to produce and maintain policies, procedures and records. It is clear, however, that the overall priority is to provide care of a high standard in a well-appointed setting. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 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 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 2 3 Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 Regulation 23 Requirement The registered person must provide covers for hot water pipes and radiators to reduce the risk of scalding. This requirement has been outstanding from previous inspections. Work must start immediately, to be completed by the timescale date. Timescale for action 13/03/06 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 1 Refer to Standard OP16 OP38OP26 OP25 Good Practice Recommendations It is recommended that all expressions of dissatisfaction and the action taken to resolve the situation are recorded. It is recommended that written confirmation is obtained 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.
DS0000018311.V257107.R01.S.doc Version 5.0 Page 18 Abbeywood House 2 31, 32 It is recommended that the owner and manager clarify and put in writing their respective roles and responsibilities to ensure effective and efficient management of the home. Abbeywood House DS0000018311.V257107.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Ashburton Office 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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