Inspection on 04/07/07 for Abbingdon House

This inspection was carried out on 4th July 2007.

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

The inspector 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 28/08/08

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

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Creative Support

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

CARE HOMES FOR OLDER PEOPLE Abbingdon House Abbingdon House 43 Thornton Road Bebington Wirral CH63 5PR Lead Inspector Julie King Unannounced Inspection 08:30 4th July 2007 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.V339857.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.V339857.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) 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.V339857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2006 Brief Description of the Service: Abbingdon House is a residential home providing care and support to 14 people over the age of 65 years who have a mental disorder. 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. Outside space for residents consists of a garden to the front of the home and a patio area to the rear. Most 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. Most of the accommodation is provided in double bedrooms. 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 usually at the basic rate set by the DWP (Currently £375) but costs may be added for any additional levels of support required. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of a key inspection, this site visit was conducted over one day; during which a full tour of the premises took place and staff and care records were examined. The deputy manager (and registered provider) accompanied the inspector throughout this visit. All staff on duty plus some residents were spoken to during this visit. There were no relatives present during this site visit, but questionnaires have been sent out by CSCI to obtain their views on the service. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 6 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.V339857.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are not able to provide assurances to residents that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: All residents have a pre admission assessment before they are admitted to the home; the manager, or one of the senior support workers in the home undertakes the assessment. Residents, family and other health care professionals known to the resident contribute to the assessment. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 9 Pre admission assessments provide an assessment of needs of each prospective resident, upon which a care plan is developed. It was suggested that the pre admission assessment tool is utilised in more detail to ensure that all prospective resident’s needs are fully identified, therefore providing sufficient information upon which to formulate a more detailed care plan. The manager reviews the assessment information to see if they can meet the prospective resident’s needs before they make the decision to accept the application for admission and offer a placement. Individuals are provided with a statement of terms and conditions/Contract before admission to the home. It gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s individual health, personal and social care needs are recorded, providing staff with some of the information they need to meet each resident’s care needs. EVIDENCE: Each individual has a care plan but practice of involving residents who use the service in the development and review of the plan is variable. The plan includes basic information necessary to deliver the resident’s care but is not sufficiently detailed or person centred. The care plan is not always used as a working document and does not consistently reflect the care being delivered. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 11 Residents who use the service are aware that they have a care plan but they are not always actively encouraged to be involved in its review or development. The standard and quality of the recording and reviews varied depending upon which support worker had completed them. Some of the recordings were contradictory in detail – one resident is recorded as having no mobility problems but within the same plan it is highlighted that they need to use a mobility aid and require assistance. Evidence was available to show that GPs, NHS services and visiting professionals were involved in resident’s care. It was suggested that the manager completed regular, documented audits of all care files and medication records to check accuracy and content of all relevant paperwork. Risk assessments are completed but these are basic and mainly focus on keeping people who use the service safe. Where limitations are in place, there is some evidence that decisions are agreed with the individual but this is not consistent. Systems are in place to ensure residents receive their medications as prescribed by their GP. Only staff who have completed appropriate training administer medications, and appropriate storage facilities are in place. Residents spoken to confirmed that they received their medication on time. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some links with the local community are in place, which help to support the resident’s lives. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in, such as outings or group activities, but the availability and recording of this is minimal. Residents spoken to said, “I would love to go out more”. Presently, the care staff are trying to carry out activities as there is no designated co-ordinator, but their time is limited due to staffing levels. Visitors are allowed in the home at any reasonable time of day, residents said that they may see their visitors in the communal lounge, smoking room or in their own bedroom. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 13 The front and back gardens are partly inaccessible and untidy, but at the rear of the building there is a small patio area for residents to get some fresh air in the warmer months. The residents said they were “well fed”, and enjoy their meals. Special diets, such as for diabetics are catered for, and resident’s food choices and preferences are accommodated as far as possible. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are aware of most adult protection procedures, thus helping safeguard the residents from risk of abuse. EVIDENCE: There is an in-house complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that service users, relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, and staff spoken to had knowledge of adult protection procedures. The home also has the latest Wirral Adult Protection guidelines that all staff can freely access. Some staff have had training around Safeguarding Adults, but in discussion with other staff they could only demonstrate a limited understanding in this important area. This leads to inconsistent knowledge and practice within the service, but the residents spoken to said that they are satisfied with the care in the home and feel safe. Residents also said that if they had any problems they felt they could “talk to the girls” (the staff). Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Most of the environment needs upgrading, which does not provide residents with a safe, clean place to live. EVIDENCE: The inspector examined the external and most of the internal premises, with the findings as follows• Garden areas to the front and rear of the property in a very untidy and partly inaccessible condition. Various items of discarded furniture rotting away in the back garden, falling down fencing and uncollected waste DS0000018851.V339857.R01.S.doc Version 5.2 Page 16 Abbingdon House • • • • • • • • • • • • skips. Patio area not fenced off in a safe manner, garden furniture requiring attention Many bedrooms evidencing very malodorous and badly stained floor coverings, damage to wall coverings and damaged and previously repaired furniture Extractor fans not working in some areas including the residents smoking room Non-domestic lighting in residents areas, some without shades or diffusers Some curtains not closing fully in bedrooms Wooden window frames rotten, in one window frame partly missing and covered with a piece of wood and a black bin bag Bathing facilities dirty, and in need of deep cleaning or replacement Lots of damaged furniture throughout the building, including bedrooms and communal areas Lounge carpet stained and worn The three seater in main lounge had cushions covered in black bin bags, and is far to low for most residents to be able to get off it unaided Most waste bins, including in the kitchen without lids Fly screen torn in kitchen Staff toilet access via kitchen only The home is not always clean and tidy, domestic cleaning arrangements are not adequate and care staff often do cleaning. A large number of the fixtures and fittings need replacing and some of the décor requires upgrading. The quality of life for people using the service is being made worse by the environment they are living in. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is limited training and supervision of staff, potentially leading to inadequate support for all residents. EVIDENCE: A selection of staff personnel files were examined but none of those seen contained all the required documents and records, such as two references, inductions and up to date training. The service does not support or encourage the development of a competent staff team. There is no comprehensive training plan and much of the training is out of date, but some staff have been encouraged and supported in the pursuing of external qualifications such as NVQs. Staff are not fully skilled to meet the specialist physical and emotional needs of the residents due to this lack of up to date training. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 18 One newly appointed staff member is legally classed as a ‘young person’, but no specific risk assessments, training, inductions or mentorship scheme was evident, which potentially places this person at risk of harm or injury. Some staff have not recently received all mandatory areas of training, such as COSHH (Control of Substances Hazardous to Health), infection control, health & safety, moving & handling, fire and first aid which should have been a basic requirement for their job. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall management of this service needs improving to ensure residents live in a home which is promotes their health, safety and wellbeing. EVIDENCE: The manager is registered with the CSCI, and has the support of an experienced deputy manager for assistance with the day-to-day running of the home. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 20 Overall this home has deteriorated (including the environment) since the previous site visit, and documented audits and checks of resident’s care files were still not available. Training, development and supervision of staff is inconsistent and staff lack leadership from the manager. Policies and procedures are not reviewed regularly or kept up to date, and quality assurance monitoring is not implemented as a core management tool. The home is drifting and appears to lack purpose and direction. Staff do not always know the content and philosophy of the Statement of Purpose, it is not routinely discussed in supervision or during training. Staff have not had sufficient or recent training to enable them to fully work safely and are unaware of any policies and procedures that do exist. There was little evidence of ongoing quality assurance, but the registered person is currently in process of collating resident’s questionnaires, and staff meetings are held on an ad-hoc basis. Risk assessments regarding environmental issues, such as the numerous trailing flexes were not available for the inspector, so it was not possible to ascertain whether or not risk assessments had been completed. The fire risk assessment was not available, nor was the staff training record to evidence fire prevention and actions to be taken by staff if a fire is discovered. The recording of resident’s accidents and incidents, especially regarding any follow-up or actions taken is not fully compliant with requirements; and does not evidence what actions the staff have taken following a resident’s fall. The small electrical appliance test, nurse call and emergency lighting and alarm test, and staff fire drill records and up to date fire risk assessment were not available on the day of this visit. Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 21 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 X X 2 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Abbingdon House DS0000018851.V339857.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(2)(b) Requirement A detailed assessment of resident’s needs must be completed to ensure staff have enough information on how to provide person centred care. Previous timescale of 31/08/06 not met. The environment must be maintained in a good state of repair both internally and externally to a good standard at all times. Previous timescale of 30/08/06 not met. Suitable and sufficient preadmission assessments must be completed by a competent person on all prospective residents prior to admission. Staff should ensure that risk assessments, e.g. nutrition, are completed for each resident to ensure. Residents should be consulted about their social interests and about an programme of activity to ensure the lifestyle DS0000018851.V339857.R01.S.doc Timescale for action 31/08/07 2. OP19 16(2) 31/08/07 3. OP3 14 31/08/07 4. OP8 13 31/08/07 5. OP12 16 31/08/07 Abbingdon House Version 5.2 Page 23 6. OP18 13(6) 7. OP26 16(2) 8. OP27 18 9. OP28 18 10. OP29 19 11. OP31 9 12. OP33 24 13. OP37 17 experienced in the home matches their expectations and preferences and satisfied their social, cultural and recreational needs. Staff must receive suitable and sufficient training on safeguarding adult’s policies and procedures so staff know how to protect service users from exploitation and abuse. Domestic staff should be employed to ensure the home is maintained in a clean and hygienic state. A staff rota showing which staff are on duty at any time during the day and night and in what capacity must be made available to ensure residents needs are met the by the numbers and skill mix of staff. The registered person must ensure that all staff complete training suitable to the needs of the residents, and that this training is documented. All persons prior to working at the care home must have had a criminal records bureau (CRB) clearance check and 2 written references taken up to ensure that they are suitability qualified to work with vulnerable adults. The registered person must ensure that the manager has the qualifications, skills and experience necessary for managing the care home. The registered person must ensure that the quality of care, is improved, and regular audits are completed to assess quality within the service. The registered person must ensure that records required by regulation for the protection of service users and for the DS0000018851.V339857.R01.S.doc 31/08/07 31/08/07 31/08/07 30/09/07 31/08/07 31/08/07 31/08/07 31/08/07 Abbingdon House Version 5.2 Page 24 14. OP38 13(4) 15. OP38 23(4) 16. OP38 18 effective and efficient running of the business are maintained, up to date and accurate at all times. The registered person must 31/08/07 ensure that all risks to the residents, staff and visitors are identified and suitable action is taken on their findings to minimize the risks. The registered person must 31/08/07 ensure that all staff complete suitable and sufficient fire training, including the actions to be taken if a fire is discovered, and the procedure for saving life, as soon as possible, and that this training is clearly documented. The registered manager ensures 31/08/07 so far as is reasonably practicable the health, safety and welfare of service users and staff by ensuring suitable and sufficient inductions and ongoing assessments and training are completed for all staff, especially young or inexperienced staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP36 OP27 Good Practice Recommendations The manager should ensure that staff are provided with one-to-one supervision not less that six times each year. The manager should routinely monitor the needs of the resident group to ensure staffing levels remain appropriate. The registered manager should restrict the use of the kitchen area by non-cooking staff to ensure that it is protected from the risk of bacterial contamination. DS0000018851.V339857.R01.S.doc Version 5.2 Page 25 3. OP19 Abbingdon House 4. 5. OP36 OP31 The manager should ensure that staff meetings are used to ensure consistency of care practice within the home. The manager should ensure they receive regular supervision from the registered provider. 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