Inspection on 28/08/08 for Abbingdon House

This inspection was carried out on 28th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbingdon House 04/07/07

Abbingdon House 16/05/06

Abbingdon House 17/11/05

Abbingdon House 05/07/05

Abbingdon House 22/11/04

Abbingdon House 11/05/04

Similar services:

Sunny Bank (P.R.S.) Ltd

Ashwood Court Unit 1

Thornton Lodge

Alfred House Residential Care Home

Barkerhouse Road (123)

Fernhaven

Thames House

Creative Support

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOMES FOR OLDER PEOPLE Abbingdon House Abbingdon House 43 Thornton Road Bebington Wirral CH63 5PR Lead Inspector Julie Garrity Key Unannounced Inspection 11:00 28th August 2008 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 Abbingdon House DS0000018851.V362022.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. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbingdon House Address Abbingdon House 43 Thornton Road Bebington Wirral CH63 5PR 0151 608 6722 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) No email Fairway Care Homes Limited Barbara Rankin Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (12) Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2007 Brief Description of the Service: Abbingdon House is a residential home providing care and support to fourteen people. From the outside Abbingdon is not dissimilar from any other house in the residential street. The service is registered to provide support for individuals with a mental health need that is due to an age related condition. Outside space for individuals consists of a garden to the front of the home and a patio area to the rear. A large proportion of the rear garden is used to provide off-road parking. Accommodation is provided on two floors with access to the first floor through stairs or a passenger lift. There are five double bedrooms and four single bedrooms; the majority of rooms therefore provide shared accommodation. Downstairs there is a large lounge/dining area and a separate small smoking room. Toilets and bathrooms are provided on both the ground and first floors. Fees charged are at £389.69 but costs may be added for any additional levels of support required or additional items such as newspapers. The home is located in the Bebington area of Wirral and is close to local shops, post office and pubs and is a short bus ride from Birkenhead town. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The site visit was carried out over a period of one day. We (the commission) arrived at the home at 11:00 and left at 17:30. We spoke with 5 people who live in the home, 2 relatives, 3 staff and the manager. We completed the inspection by a site visit to Abbingdon, a review of records available in the service, these included care plans, medications, staff training, staff recruitment, policies and procedures, daily records and maintenance records. We also looked at records held in by the commission this included an annual quality assurance assessment. (AQAA), this is completed by the service before we visit and gives us an update of their progress to meet quality. The main emphasis was discussions with the people who live in the home, staff and management. Questionnaires were sent to the home for people who live in the home and five were returned prior to completion of this report. All of the key standards were covered in this inspection; these are detailed in the report. Feedback was given to the manager during and at the end of the inspection. The arrangements for equality and diversity were reviewed throughout the visit and are detailed in this report. Particular emphasis was placed on the methods that the home used to determine individual needs and the practices that they put into place to meeting those needs. What the service does well: What has improved since the last inspection? Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 6 Visits are done before people move into the home to look at their needs. We call this a pre-assessment. These pre-assessments now include details about the individual’s mental well-being. The manager said that she visits people before they move in and does a “brief” outline of individual this is updated within the first few days after the person moves in. There have been improvements in the environment, the carpet in the main lounge/dining area has been replaced, some damaged furniture has been replaced and a bathroom has been refurbished. This has improved the appearance of the home. The service has employed a housekeeper to undertake all the cleaning duties this has freed the care staff from these duties. The home was clean and smelt fresh at the site visit. Of the five questionnaires all said that the home was clean and fresh the majority of the time. What they could do better: There are a number of areas that remain outstanding of particular concerns is the lack of understanding of the staff and manager with regards to the process involved in safeguarding adults who live in the service. The service did not have its own policy available at the site visit that would support how serious concerns would be managed. Since this visit a copy has been made available and is to be updated in line with social services adult protection. Two staff had started working in the home within the last two weeks, neither of these had police checks available at the site visit. Staff cannot be employed within the home without a police check unless the circumstances are exceptional, the police check has been applied for, the staff member does not work unsupervised and full work references are in place. The lack of a police check, supervision and working references for both places individuals at risk. There have been no improvements in training for staff and no plan was available that made sure that all staff had the training they needed. None of the staff had up to date moving and handling. The manager said that they do not move individuals, as they are all self-caring. There had been no consideration of other items within the home that staff needed to do or what staff would do if someone fell and needed to be lifted off the floor. Other training such as adult protection, first aid, fire safety, health and safety or training specific to the assessed needs of individuals was not available. A lack of training places both staff and individuals at risk. Care plans were in place but these were variable in quality and did not give clear instructions to staff as to how to meet individual needs. A lack of clear instruction may result in inconsistent care being delivered to individuals. There has not been any developments regarding the monitoring and development of quality in the home. There are no audits in place to determine the strengths and areas for development and no plan as to how the service can Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 7 increase the quality of the service. Policies and procedures were out of date, not available or very brief. This did not provide staff with current instructions, support and guidance that they need in their roles. There is limited activities available within the home and little determination of what individual choices, routines or personal preferences are. The AQAA submitted by the manager stated that they needed to increase the independence of individuals but had no plans as to how they were going to do this. 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. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed 1, 2, 3 and 4. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are given the opportunity to have an assessment before they move in. This helps the staff determine if they can meet their needs. Information available does not support individuals and staff to make an informed choice about whether the service can meet people’s needs. EVIDENCE: All people wishing to move in the home have a pre admission assessment before they are admitted to the home. Those viewed had been completed to a good standard and covered a lot of mental health issues. There was no information regarding equality and diversity, nothing related to age sex, religion, culture or sexual orientation. There is a section for personal preferences but this has only minimal information. Without this information the home will be unable to determine if they can fully meet the individuals needs in particular their social needs. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 10 There is a statement of terms and conditions/contract that give basic information on what people who live in the home can expect to receive for the fee they pay. This is not in good detail and does not fully outline the services provided. Of the four that we viewed all were dated several years ago and as such did not reflect the current fees in place. We received five replies to our surveys all said that they had not received a contract. The reason that this was not in place was due to information from social services, which said it was not necessary. The owner has plans in place to make sure that all people living in the home have updated information available. The home has a information in place this does not include information regarding the admission criteria that would help inform the manager, staff or people wishing to move in of the skills of staff and what needs the service can meet. Our surveys asked people, did you have enough information three said yes and two said no comments included “we did not have a choice about the home” and “Not had anything written down, but we were told a lot about the home before moving in”. Staff spoken with one carer on duty acting as the cook and the deputy manager not aware of a service users guide. We spoke with some individuals living in the home who told us they could recall having seen any information about the home. We looked around the home and noticed that no information was available in any public areas. Relative spoken with did not recall seeing any written information. One relative spoken with that when her relative was admitted he took one look and said, “this is for me”. They found the staff welcoming and homely. Not overly fussy and her relative has significantly settled whilst he has been living in the home. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are met. Information for staff is not always clear and prevents them from being sure that they are supporting individuals in a manner to meet their needs. EVIDENCE: Records showed that external medical experts are accessed as needed. People living in the home have good access to their own local doctor. Individuals spoken with said “if I need to see a doctor staff sort it”, “I go to medical appointments usually a staff member comes with me” and “staff make sure if (my relative) is not well we get told and they get to see the right person”. The recording of medications was unclear examples included not recording the amount of medications left from the previous month this meant that medications could not be fully looked at by either us or the manager. Other Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 12 examples included a lack of instructions to staff for medications when needed as without clear instructions staff run the risk of giving these inappropriately. The manager said that she does not regularly audit medications in order to make sure that they were given correctly. Good practice included handwritten medications were clearly written with two signatures and photographs of individuals were available with the medication records. Some medications in particular creams are given to some of the individuals to manage themselves but there are no risk assessments in place that support the individual to mange this safely. Staff had training in medications a few years ago; some are due to update their medication training. The manager said that this has been arranged through their dispensing chemist but there is no firm date for this. We looked at four care plans. Care plans did look at the individuals needs. There was no evidence that these were discussed with individuals and families. We spoke to individuals and relatives who confirmed that they had not seen the care plans. The majority of plans viewed were brief and did not give clear instructions to staff on how to support individual needs. There were plans in place for identified risk such as falls but this made no mention of how the risk was to be monitored referral to falls clinic, shoes, equipment as examples. Plans for psychological need were available we reviewed these and found that there was no description of behavioural needs, what events produced certain behaviours and how staff were to manage this. The majority of plans were physical needs based when in fact the majority of individuals did not have physical needs. Without good plans staff will rely on verbal communication and this runs the risk of them providing support that does not consistently meet individual needs. Daily records were clear and gave a good impression of what the individual had been involved with that day. Social interactions, personal preferences and choices were not detailed. Where medical needs were identified and external professionals such as doctors, chiropody and opticians were needed this was recorded in the records. There were a number of risk assessments in place but confusing as to what their purpose was. As an example risk assessments for falls was in place, but gave no specific details, smoking risk assessments were limited and did not determine why the choices that had been made had been done or what actions were needed to be taken by the staff. None of the care plans seen had been signed by the individual or their relatives and there was no evidence that this had been discussed with them. Surveys were sent and five returned one question asked. Do you receive the care and support you need all five said yes. One qualified that with “most of the staff are excellent, occasionally some don’t understand very well but they keep trying until they do”. A further question asked, do staff listen and act on what you say. Four responses were yes. One individual wrote, “very good staff Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 13 a small group so it’s more like a family”, another comment was “Staff often think they know what’s best”. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited range of daily activities and choices within the home means the individuals do not have a full range of opportunities that suit their diverse needs. EVIDENCE: During the site visit we were not able to observe any activities as none occurred. Three individuals did leave the home for a large part of the day to attend a local day centre. For the majority of the day people living in the home were seated around a television in the main lounge a large wide screen TV an old film was playing. Individual records did not show any planned activities or any plans to maintain independence; little information was available about the inclusion of relatives in individuals lives. The manager told us of residents meetings in the AQAA when asked to produce minutes she was able show a book with summaries in them. Minutes are not written out and circulated amongst individuals. The book did detail what aspects individuals would like include in their daily lives. No activities plan was available either for the home or for individuals. Individual social or daily life Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 15 preferences are not recorded. There is no individual employed to provide activities and no evidence that staff have received any training in providing daily life activities for individuals. Survey information confirmed individual’s opinions of activities one question asked. Are there activities arranged by the home that you can take part in. Two responses said always, one said usually, one said sometimes and one said never. Comments were “Don’t like to join in like to do my own thing”, “if you like watching telly there’s plenty to do” and “we go out sometimes, but I’d like to get out a lot more”. The service has no policies and procedures regarding equality and diversity, staff receive no training in this area and as previously stated their assessment does not review this need. There is little or no discussion with individuals as to whether they would wish to be attended to by a male or female and the majority of the staff are female. This practice does not meet individual equality and diversity needs. Menus were not widely available, individuals were not aware of what the meals were to be. An individual normally involved in care was cooking on the day of the site visit, as the cook was not available. It was not possible to find a record beyond October 2007 that recorded fridge temperatures although food temperatures were recorded. The manager said that none of the staff have training in catering for special diets. Training records viewed also confirmed that staff had not received training in dealing with special diets. The menu had been drawn up by the manager. It had not been reviewed for nutritional content and the manager said she has no training in that area. The manager said it was impossible to get many of the individuals to eat healthy food. Menus in the kitchen did not show any alternatives or concession to special diets such as low cholesterol it was not possible to determine that the individual who needed a low cholesterol diet was receiving one. Surveys showed that one person said always they always liked the food, one said usually and three said sometimes. Comments included, “its mostly tasty, but not very exciting”, “not a lot of choice seems to be the same things all the time” and “I like the food”. The home is registered for mental health, there are fourteen people living in the home with two staff available at all times. None are admitted for physical needs all are reasonably mobile and self-caring with supervision and encouragement. There are no life skills opportunities, individuals do not get involved in areas such as laundry, cooking, cleaning. Some individuals do have items like a kettle in their rooms and these are appropriate risk assessed and good practice. Some people who live in the service are not afford the same choice of food as others if they are not present at mealtimes. Staff do not leave food over and as such the choice is limited. Staff are supporting some choices but need to make sure that they offer the same alternatives to encourage independence. Another individual was spoken to who discussed their choices with us. The Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 16 manager said that the individual couldn’t express a choice so they choose the meals and clothes for them. This persons choices were not recorded and there was no plan available that detailed how staff were to support their choices. The manager said, “we know what they all like”. As there is a lack of records available that identifies and records individual choices and none of the staff have received training in the mental capacity act. It is not good practice that the staff and manager make choices for individuals based on very little information. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 17 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): Standards reviewed 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home say that feel safe and staff listen to their concerns. A lack of procedures that safeguard people living in the service, prevents staff from fully understand and managing serious concerns in a manner that meets individual needs. EVIDENCE: Information from surveys showed that. Four individuals knew how to make a complaint and one said they did not know. Comments included “I would need to raise any concerns for him (individual in the home). But I would anticipate that it would be dealt with before it got that far”. When asked do you know who to speak to if not happy. Three replies said always, two said usually. Comments included “the manager is here everyday and the staff are great any issues I would discuss with them”. There was no policy or procedure made available to the commission about safeguarding or how to deal with a complaint. A copy of the whistle blowing policy (in which staff are supported to raise concerns) was not available to us. The manager explained that they were available but just could not find them on the day of the site visit. We discussed with staff their understanding of what happens when a concern is raised. These discussions showed that staff where not aware of how these issues needed to be dealt with once reported to Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 18 the manager. Without clear policies and procedures and an understanding of how issues of this nature are dealt with, staff run the risk of not dealing with serious concerns in a manner that protect the individual. Staff could not recall any recent training in adult protection and could not recall seeing the homes own policy and procedure. More long term staff have had training but there was no records of staff having received training in this area for over two years. Two newly recruited staff members were put on to nights on sleeping duties. Neither had a police check in and there were no risk assessments in place or records that they were being constantly supervised until the police check was obtained. The manager described an event the day before when a complaint had been made. The family had raised their concerns with staff in the home. There was no written records of the compliant or actions that were taken to resolve the situation. Without good records the manager will be unable to monitor complaints and make sure that they are fully dealt with. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 19 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): Standards 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Although the general environment has been improved. Infection control practices are in need of further developement to help prevent the spread of infection in the home. EVIDENCE: Garden areas to the front and rear of the property have been tidied and a summerhouse made available for individuals to use. There is a variety of seating in the garden that people can use. Some of the lighting in the building is still not in keeping with a domestic setting. The issues identified at the last site visit regarding missing lampshades, curtains not closing and window repairs have been addressed. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 20 A new shower room created that is decorated to a good standard. Some of the furniture has been replaced and new carpeting is now in the lounge area of the home. Individual surveys asked is the home clean and fresh, three replied always and further two said usually. Four individuals spoken with all said that they liked the way the home looked “did not want anything fancy”, “I like it the way that it is” and “its much better lately”. A relative spoken with said, “we choose it as (the individual) would never have wanted anything fancy”. A new domestic staff (house keeper) has been employed. This seems to have made a difference as all areas were clean and tidy. The laundry room was clean and tidy but was not well organised and relies on staff understanding individual items of clothing and recognising them. Net pants for use with continence pads aids are not named as such these can end up with different people. This practice is undignified and does not reduce the risk of infection. There are no policies available for infection control. Records regarding staff training were unclear and it was not possible to determine that all staff had had infection control training, food hygiene or control of substances hazardous to health. A lack of training and guidance in preventing the spread of infection can place individuals at risk. There are five double bedrooms and four single rooms the majority of bedrooms are shared. All those viewed had screening facilities available to maintain dignity. Hard soap was noted in three of the shared bedrooms and no soap in four bedrooms. Hard soap was in shared rooms as this was not named to the individual it can be used by either person presents a risk of spreading infection. The records viewed do not have agreements in place with individuals that they agreed to share a bedroom. Abbingdon House DS0000018851.V362022.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): Standards reviewed 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are not fully checked as suitable, before they start working and staff training is not up to date. Both these may lead to individuals not receiving the care they need or having their interests safeguarded. EVIDENCE: We reviewed three staffing files and looked at how the staff members were checked as suitable before they started working in the home. All staff files were well organised and information in them was easy to find. We noticed that two new staff had not been checked fully before they started work. Neither had a police check in place, one member of staff had no working references and an unaccounted for gap of over a year in their employment history. The manager stated that she thought staff could work without a police check as long as the police check had been requested and the check know as PoVa first had been done. New members of staff can be recruited without a police check in exceptional circumstances, where individuals are placed at risk if new staff are not in place. In those circumstances the staff member must be fully supervised. Both new members of staff have been recruited within the last fortnight. The manager explained that there were no exceptional circumstances, that the members of staff were still working through their Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 22 induction and both staff were doing sleeping duties overnight without constant supervision. Not having robust recruitment practises could place people living at the home at risk. We looked at the training for staff and found that there were no records that staff had received training in Adult Protection, fire safety, moving and handling, health and safety or food hygiene for over a year. Staff spoken with and the manager confirmed that this was correct. The manager own adult protection training was several years ago and has not been updated for some time. Staff spoken with could not recall training in these areas. There was no training plan that identified what training staff had or what training they needed. We were unable to identify training specific to the needs of individuals living in the home. Without training to meet the needs of individuals staff will not be able to fully meet individual needs. There has been an increase in staff in so far as a housekeeper is employed. This is an improvement on the previous site visit where staff undertook cleaning duties. Staff are still responsible for laundry, care and activities. There are two staff available during the day and two of a night with one individual on sleeping duties. Staff spoken with thought that there was enough staff during the day as individuals are physically independent and need “monitoring” with physical needs. Individuals spoken with thought enough staff available but would like to get out and about more. “very nice bunch”, “oh they are really kind”, “Could not ask for a nicer bunch of people they try very hard”. There are good relationships between the people living in the service and the staff. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed 31, 32, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are no arrangements in place that look at and increase the quality of the service. This has lead to a minimal improvement in some areas of the service. EVIDENCE: The manager has worked in the service for many years; she is well liked by individuals living in the home, staff and relatives. Although she has achieved training in management, she said that she has not had any training in Mental Capacity Act. She also explained that she did have a qualification in mental health. She explained that she has infection control, dementia care training and adult protection in the last 12 months. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 24 We looked at how the home recognises and deals with identified areas of improvement. There is no clear quality assurance system that monitors the service and increases the quality. A variety of areas such as care plans, medications, staff management and accidents are not regularly audited. The manager said that questionnaires are sent to people living in the home however copies of these were not available for review and are not included in the quality assurance system. We noticed that several items essential to quality and maintaining health and safety were not available these included: fire risk assessments, environmental risk assessments, staff training in Health and Safety, adult protection or fire training for staff. There are a number of requirements made at the previous site visit that have not been dealt with. The service has not improved in quality since the last site visit despite investment in the environment. We looked for other items that may indicate plans to develop the quality and noticed that they were not in place this included no staff training programme being in place, no maintenance plan, staff checks for all staff not in place and risk assessments for self-medicating clients. The lack of these areas being addressed and out of date or missing policies and procedures could place individuals living in the home at risk of receiving inappropriate support. The majority of individuals do not pay for their own care and as such money is left with them by their families. Some however do receive funds known as a personal allowance. This information would be in the contract or terms and conditions; none of the contracts viewed were in date. All monies had specific records of when given to the individual or what it was spent on these were good records and help safeguard individuals. Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 25 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 2 2 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 2 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 X X 2 Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 26 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 OP18 Regulation 13(6) Requirement To help prevent people using the service being at risk of abuse, arrangements must made to ensure staff understand adult safeguarding and that adequate policies and procedures around safeguarding are introduced and implemented within the home. Timescale for action 28/10/08 2. OP29 Outstanding from 31/08/07 19 (1) (a) To ensure that people who (b) (i) (ii) receive the service are safe, (3) (4) (a) arrangements must be in place (b) (i) (ii) to ensure staff are properly (iii) (c) vetted and checked, including (5) (a) (b) police, reference checks and (c) (d) receiving appropriate supervision. Outstanding from 31/08/07 28/10/08 3. OP33 24 (1) (a) Arrangements need to be put 28/10/08 (b) (2) (3) into place to review the quality of the service. This system needs take into account and represent the views of people using the service. This system should also consider the views of other stakeholders. Outstanding from 31/08/07 DS0000018851.V362022.R01.S.doc Version 5.2 Page 27 Abbingdon House 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 OP1 Good Practice Recommendations All service users guides and statement of purposes need to be updated and readily available to individuals living in the service in formats to meet their equality and diversity needs. These needs to include a criteria for admissions, none smoking arrangements, only showers available as examples of necessary information to help people make an informed choice. All individuals need an up to date contract or statement of terms and conditions that also includes a breakdown of the fees and individuals personal allowances. All care plans need to be reviewed and give staff clear, individual and specific instructions on how to meet individual care and support needs. The individual or their family representative need to be included and agree to the care to be provided. The medications policy needs to be reviewed, training of staff updated and audits put into place to determine the competency of staff and that individuals are receiving the medications they need. This needs to include information about carrying forward medications, recording given medications, per required need, self-medicating risk assessments and “homely” remedies arrangements. The manager should routinely monitor the needs of the people living in the home to make sure that staffing levels remain appropriate. Records on training need to be kept up to date in order that gaps in staff training can be identified sand addressed. To help ensure the health and well being of people using the service, risk assessments should be developed to identify and reduce the risk occurring. For example were people self medicate and fire risk assessments. 2. 3. OP2 OP7 4. OP9 5. 6. 7. OP27 OP28 OP38 Abbingdon House DS0000018851.V362022.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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. 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