Inspection on 26/04/07 for Abbots Leigh Manor Nursing Home

This inspection was carried out on 26th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abbots Leigh Manor Nursing Home 03/01/06

Abbots Leigh Manor Nursing Home 06/09/05

Abbots Leigh Manor Nursing Home 25/01/05

Abbots Leigh Manor Nursing Home 30/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Abbots Leigh Manor Nursing Home Manor Road Abbots Leigh North Somerset BS8 3RP Lead Inspector Barbara Ludlow Unannounced Inspection 26th April 2007 10:00 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 Abbots Leigh Manor Nursing Home DS0000020295.V335663.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. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbots Leigh Manor Nursing Home Address Manor Road Abbots Leigh North Somerset BS8 3RP 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) 01275 374669 01275 374669 Treasure Homes Limited Ms Katheryne Bauer Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 66 persons aged 65 years and over. Person in Charge must be a RN on part 1 or 12 of the NMC register To admit a named individual (Variation application 4.5.06) aged less than 65years, for general nursing care at the home. 3rd January 2006 Date of last inspection Brief Description of the Service: Abbots Leigh Manor is registered to provide nursing care for up to 66 residents. Treasure Homes Limited owns the home. Mr Gillespie is the responsible individual for the home and Mrs Bauer the registered manager. The main house is a converted and upgraded property situated in pleasant gardens with expansive views over the surrounding countryside. Accommodation is provided in mainly single rooms on four floors. All the rooms have en suite facilities. There is a wide range of communal space. A passenger lift provides easy access to all floors. The ramped corridors ensure that wheelchair users can reach all areas of the home. The weekly fees range from: £625.00 to £795.00. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Two inspectors carried out this unannounced key standards inspection over a two day period. The first day was unannounced and the two inspectors spent seven hours at the home. The second visit was a week later made by one inspector and by appointment with the manager. Overall this was a very positive inspection. The inspection was well received and the inspectors met with Mrs Bauer, her staff team and the service users in residence at the home. The proprietor, Mr Gillespie was available on day one and the home’s administrator with access to records and contract information, was available on both days. The last inspection report and progress made and the pre inspection questionnaire were discussed with Mrs Bauer at the start of the inspection. Sixty four service users were in residence at the time of the inspection visits. The inspectors toured separate areas of the home and met with service users, their visitors and spoke with staff. The medication administration was examined on day one and the stocks of controlled medication were checked against the controlled drug register entries. Records including staff recruitment files and training were sampled on day one and the care plans, contracts and maintenance records were examined on day two. The lunchtime meal served in the dining room was seen on both days. Feedback was given to Mrs Bauer at the end of each inspection visit. Written feedback was requested from service users, relatives and visiting professionals. 29 completed forms were returned to CSCI, comments made are included in the body of the report. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home is fine tuning the auditing processes. A survey about the food as recently as March 2007 has resulted in some changes being made to the menu. The written service user comments to CSCI had included ‘would like a change of menu’, and would like ‘more fruit and vegetables’. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 7 Redecoration and upgrading of the premises is carried out on a rolling programme and as necessary when a room is vacated. One service user with an en suite shower room said they would prefer a bath; this was changed to meet with their preference. What they could do better: 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. Abbots Leigh Manor Nursing Home DS0000020295.V335663.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 Abbots Leigh Manor Nursing Home DS0000020295.V335663.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): 2,3,4,5 Quality in this outcome area is excellent. There is a good level of information available about the home. Visitors are invited to look around and are welcomed. Detailed pre admission assessment and consultation is made to ensure that care needs can be met following admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home always gives existing residents first refusal of any newly vacated rooms. There have been no changes to the statement of purpose or service user guide. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 10 During the inspection a prospective service user’s family made a visit to the home. On arrival they were heard to be warmly greeted by the home’s receptionist. The pre admission assessments were sampled for more recent admissions and service users were spoken with about the admission process. The assessments made are very thorough to ensure that the assessed care needs can be met. The assessments had a very positive emphasis and detailed health care information. The home has good communications with the community health care services and relevant information to inform the admission decision making process was seen on file. Careful consideration of complex care needs and consultation with staff was demonstrated. The manager ensuring that the staff team have the skills, equipment and resources to fully meet care needs of a person prior to their admission being confirmed. Inventory of belongings brought into the home is recorded. Relevant contacts and personal details are clearly recorded. Contracts are issued and admission into the home is confirmed in writing. The contracts sampled detailed the costs of care. The Registered Nurse Care Contribution is refunded at the low and the middle band. The inspector was informed that extra charges are made for hairdressing and chiropody, newspapers and complimentary therapy such as aromatherapy. £1.00 per week is currently charged for telephone rental and there is currently no charge for local calls. If all toiletries are supplied by arrangement then there is an agreed charge of £5.00 per month (current rate). If a service user requires a staff escort for an appointment away from the home a charge of £10.00 per hour is declared. Small amounts of spending money can be left for safekeeping with the homes administrator. This was all recorded, withdrawals are signed for and two monthly statements are issued, staff access is appropriately restricted. There is safekeeping for small items if required, such as a wallet. Following admission a ‘settling in check’ is made, to hear the service users and families experience and look at any areas that need attention such as the care plan, relationships or anything that may make the stay more comfortable. One example recorded in a care plan had a request for a repair of a television. A newer resident told the inspector that the staff couldnt do enough - they made me welcome. One relative stated in the written feedback that they ‘would have no hesitation in recommending Abbots Leigh’. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 11 Service users asked said they had chosen the home because they had heard good reports of the home locally. Two relatives were asked about their experience of finding the home. Their research had been via yellow pages but they were very pleased to have made (for their relative) ‘the right choice’. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 12 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 excellent. Care plans are person centred, detailed and regularly reviewed. Personal and health care needs are met and medications are safely managed. Service users are treated kindly and with consideration for their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors toured the premises and spent time in the communal areas of the home. Service uses were seen in private in their bedrooms and in the communal areas of the home. Daily life was observed as unobtrusively as possible and visitors to the home were spoken with. Frailer people looked well kempt, and staff had paid attention to detail, ensuring that peoples spectacles were clean and nails well trimmed. People who were able to describe the support they are given with personal care told Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 13 inspectors that they are never made to feel rushed and that care is given with tact and consideration. Residents said that staff give them support where they need it but are very good at letting them get on with the things they are able to do. This helps people to maintain or increase their level of independence. One resident said, they look after you but no-one intrudes. Lunchtime was observed. The dining tables were nicely presented and aids to assist independent eating were available. Staff gave one-to-one support in the dining room to people who needed help with eating. This was done in a very low-key manner. Staff faced the person and gave them their full attention, chatting to them even if the person was not able to chat back. Staff took care to explain what was on the plate, and allowed the person to eat at their own pace. Residents told the inspector that staff respond quickly if they ring the call bell. There was a problem recently with the call bells in the garden rooms, which was promptly resolved. Rather than risking a recurrence of this problem, the home opted to install a new call bell system and panel. Care plans are held on the home’s computer system. The inspector was given full access and was able to view past records and present care plan details. The information is very clearly recorded and was very detailed providing an excellent guide to caring for the individual service user. The risks associated with daily life and health and well being had been assessed and recorded. The home uses the MUST nutritional assessment tool and Waterlow pressure sore risk assessment. One recording was seen that was not fully completed and was underscored. Although this was not detrimental to the care of the service user in this instance, more care should be taken to make complete assessments. The care plans had been reviewed and were up to date. One relative was very complimentary commenting in writing that they are ‘very happy with the care’ of their relative and that their ‘health and well being is maintained’ they have opportunities to speak to the staff. They also commented that they are not invited to ‘formal reviews’ of care with the visiting professionals, this may be an area the home could ask the visiting professionals to address. Medication storage and the administration records were seen and examined. Medication administration records had been signed and with three exceptions there were no gaps on the administration records. The administration of Warfarin for one service user was appropriate but it not made clear where the direction for the dose was recorded. This was brought to the manager’s attention. Controlled drug stocks were checked against the records, the stocks tallied satisfactorily. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 14 A number of service users self medicate, this was assessed and lockable storage is provided. On day one of the inspection, one service user who is self medicating was seen to have left their tablets unlocked in their room. Locked storage had been provided but the situation warranted a review of the suitability of the storage facility for this service user. A record was made on a MAR chart for the staff to remind one service user who self medicates but who may forget. This was evidence of enabling practice. A care plan for a deceased service user was examined. This care plan demonstrated good care practice. The care plan detailed contacts made with the G.P and the family. Contacts had been alerted appropriately to any changes in health and condition. Pain management was evident. The refusal of medication had been supported. The regularity of entries in the care records increased with the care interventions and changes in health and medical intervention. There was clear evidence of a good level of nursing care provision for this service user and of support for their family. The home is well equipped and the nursing staff receive training and updating to be able to meet the needs of the service user group accommodated at the home. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 15 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 excellent. Social care has been improved; service users have access to a range of social events and activities at the home. Families and friends are welcomed into the home. The food is varied and wholesome. Mealtimes are social occasions and thoughtful discreet assistance is given if required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home sent out activities surveys to a number of residents last year and again in January this year. The second set of questionnaires pitched the questions slightly differently and introduced new questions. Respondents replies showed that people feel able to comment negatively. Quite a lot of respondents said they would like more one-to-one time and more accompanied walks. The home has now arranged for two of the activities staff to spend one-to-one time with residents for one morning each week, and to take Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 16 residents out for short local walks for another morning each week. Activities diaries reflected this increase, and one of the residents the inspector spoke with also mentioned that walks outside have become more frequent. One of the care staff works an additional four hours at least a couple of afternoons each week to take residents out or spend one-to-one time with them. One of the activities coordinators hours has recently been increased to 20 per week. The activities file now contains the profile of each persons interests and hobbies, a note of their preferences and any special requests, and also an individual diary of activities. The inspector looked at half a dozen peoples activity diaries, and most of these showed some sort of planned activity or one-to-one time every few days as a minimum. Sherry mornings are held regularly, and in nicer weather good use is made of the attractive garden. Visiting entertainers provide regular music and movement sessions, singing and other musical activities. There is also an art class. The activities diaries include a note of whether the person enjoyed the activity and found it easy to join in. This helps the home to plan future activities schedules. The diaries also showed that individual preferences are being well met. For example, one person does not really enjoy socializing or formal activities, so this person has a daily visit from one of the activities coordinators, just to have a chat. Other examples also came to light of how the home is working to meet a range of individual needs. The weeks activity schedule was posted on the main notice board but individual residents are also given a copy. Some sort of activity is arranged for each weekday morning and afternoon. There are regular outings, either locally or further afield. Residents and staff were enjoying a sherry in the lounge were discussing yesterdays trip to Exmouth. Everyone the inspector spoke with commented on the homes relaxed atmosphere. Several people said there are no rules and one person said, Its not regimented - you can do as you like. People said that routines are very flexible and they can follow their own routine to a great extent. One person said that she tells staff what time she would like a bath, and they turn up at that time to help her. This person added, It couldnt be more like home - first-class!” Visitors all said how relaxed they feel coming to the home and that they are welcome whatever time they arrive. One relative told the inspector that visitors could make their own hot drinks in the kitchen but that staff usually offer a tray of tea when they arrive. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 17 Written comment supported that service users have a choice of whether or not they participate in activities and in how they spend their time each day. Service users commented that they ‘liked their bedroom’ and enjoyed the views from the home. The home’s staff had prepared and performed a pantomime at Christmas, this was reported to have been ‘fun’ and was performed three times, including once for the company’s nearby residential care home Lampton House, who were invited to Abbots Leigh Manor. Residents were generally very satisfied with the quality of meals. One person commented on how beautifully served they are. The inspector overheard a member of staff taking a meal to one resident in his own room. His response when he saw the large and very chocolaty pudding was Oh God, and the staff member immediately asked Would you like something else? I can check in the kitchen what else theyve got. The day’s lunch and supper menus were displayed on the dining tables, and evening staff ask each person about their meal choices for the following day. Residents said that there is a good degree of choice: as well as the two choices shown on the menu, chefs are very flexible about providing further alternatives. The chef keeps very detailed notes of each persons likes and dislikes, and also talks to residents occasionally about what they think of the meals and any ideas they have. A few people have told him that they would like more vegetarian meals, so the menus are now being changed to include this. Service users responding in writing had commented that they ‘could have second helpings’, ‘would like a change in the menu’ and ‘more fruit and vegetables’. The menu changes have been made and only one negative comment was heard at the inspection. Service users reported having enough to drink and one service user said they had an early morning cup of tea at 6am. Puréed meals for people with eating difficulties were presented nicely, each ingredient being separately puréed so that the meal looked more colourful and appetising. There was a very pleasant atmosphere in the dining room. Residents and staff chatted with each other occasionally, and staff carried out their duties quietly and discreetly. Music from the 1940s was playing quietly in the background. Residents looked like they were enjoying their meals. On day two of the inspection a clothes show was held in the lounge. Many service users were seen enjoying shopping and looking for new clothes, staff and relatives were seen giving assistance. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 18 Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 19 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 excellent. There is a complaints procedure. The home has recruitment policies and procedures to underpin best practice and protect service users from harm. Service users and relatives spoke with confidence about raising concerns and having them dealt with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is posted in the hall and gives the contact details of the manager, responsible individual, and CSCI. People told the inspectors that they can complain freely, and that they always get a positive response and prompt action if they do. One person said that, if she asks for anything, the response is immediate. Many people commented that they never have to complain, but that any concerns or grumbles are satisfactorily resolved before they can become more serious. Many of the people the inspector spoke with praised the staff team for their openness to listening to criticism. One person said that there is never any defensiveness people really want to know if something isnt quite right. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 20 There is a Thank You file in the reception area, and this contained eight cards or letters sent by relatives since January this year, warmly praising the staff team and the quality of care. Staff asked were aware of their role in protecting vulnerable people in their care from harm. Recruitment files demonstrated attention to sound recruitment practice and the taking up of criminal record checks for staff prior to them commencing work at the home. One service user and the activities organiser were asked about the civil process. Opportunities had been given to service users to vote in the recent local election. Two service users had gone out to vote and one service user confirmed having been enabled to make a postal vote. The written feedback to CSCI included that one service user ‘was aware of the complaints procedure’ as this had been ‘explained in detail’. One relative stated that they had ‘sixteen months good experience’ of Abbots Leigh Manor. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. Service users live in clean, comfortable and well appointed accommodation. The environment is suitably adapted and well equipped as a nursing home. The home has a good level of communal indoor space and pleasant grounds. Bedrooms can be personalised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is an attractive adapted building with a pleasant outlook and accessible level grounds. The home has a reception area with office hour’s receptionist. Visitors sign in and out when visiting the home. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 22 The bedrooms and communal areas are well appointed and comfortably furnished. The home has large windows and the level of natural light around the home is good. Bedrooms can be personalised by the service users. There is a dining room / day space where one part of the room is used as a nurse station. Staff have access here to the computer and to store the medication records and medication trolley. Care must be taken to ensure the computer screen is closed after use (the inspector was informed later that there is a two minute time delay to the screen saver) and that medication records are not compromised. More discreet and safe storage is recommended at this inspection. Staff personal items are left in this room, this may not be the safest place to leave personal property and a review is recommended. This was not discussed in detail at the feedback session at the close of the inspection days. The home is maintained to a very good standard, several residents and relatives told the inspector that any necessary repairs are done promptly. The home had a warm ambient temperature and an effort was made to keep one service users room warmer to meet their need. The home was found to be very clean and fresh smelling in all except three identified areas. One of these areas was the laundry facility. Here a grated drain was seen to be clogged with lint and was the source of an unpleasant odour. Attention was paid to remedy this between inspection days and the management agreed to monitor this. Odour control for the other areas was in hand. There are assisted bathing and ‘wheel in’ shower facilities and the home has sufficient toilets and sluice facilities. Infection control is well managed with the provision of personal protective clothing for staff (gloves and aprons), appropriate hand washing facilities and waste collection. The kitchen was clean and tidy. Fridge temperature records were up-to-date. Kitchen staff have lists of daily cleaning tasks, which they initial as each is completed. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 23 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 excellent. The home has a registered nurse on duty at all times and supported by a skilled mixed care staff team in sufficient number to meet the care needs of service users. There is a sufficient ancillary staff team. All staff are recruited, trained and supported in their roles at the home. The service users confirmed their confidence in the staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were 64 service users in residence and one person was due back from hospital on day two of the inspection, demonstrating the homes high occupancy status. Rotas show high staffing levels. As a minimum, the home provides 3 nurses on the early shift and 2 on the late shift. 11 care staff on the early shift and 8 on the late shift support the nurses. There are 2 nurses at night and 4 night care assistants. Residents and relatives comments showed that staff are always readily available, and staff also told the inspectors that they feel able to do their work thoroughly and at a relaxed pace. One person commented that they have time to build a proper relationship with the residents and get to know each other. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 24 Although there are already as many as 8 cleaners on duty at a time, an additional cleaner is being employed to ensure that areas such as the laundry room can be kept clean throughout the day. See environment. Each member of staff has a contract that covers their terms and conditions, the code of conduct, and the disciplinary and grievance procedure, among other issues. There are pay increments for good performance, weekend or bank holiday working, additional experience and qualifications. Staff are rewarded for developing their care skills. The staff files sampled showed that the home is following safe recruitment practice. All the necessary checks are completed before new staff start work on the home. The home also takes care to employ staff with a positive attitude to older people. The success of this approach is demonstrated in the calibre of staff the inspectors met. Staff were enthusiastic when they talked about their work, and showed real commitment to the home and its residents. The residents and relatives inspectors met during this visit confirmed that staff are invariably willing and cheerful. One resident told the inspector, Ive never met an unpleasant person here. There was a strong sense of team spirit from the staff, and many people described being fully involved and feeling valued. One person said, Everyone pulls together, from the bottom to the top. Several staff said that they have fun as well as working hard. Each new staff member has a thorough induction training and works alongside a mentor for the first couple of weeks. The inspector spoke with a member of the domestic staff. They had been given training in safe use of cleaning chemicals, and knew where to find safety information on these chemicals. Other staff described a good range of training opportunities, and told the inspector that the home pays for all their training, even above the level of training that is required under the Care Standards Act 2000. Recent training included dementia awareness, PEG feeding systems, venepuncture, and end of life awareness. One of the nurses is a qualified manual handling assessor, as are three of the night care assistants. Each of the staff the inspectors met felt very well supported, both by the helpful attitude of other team members and by the management staff. Each person has an alternating one-to-one supervision session with the manager and a performance appraisal at approximately six weekly intervals. Performance is linked to a pay bonus. Staff felt that supervision is done in a very supportive way, and that they are helped to develop rather than criticized. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 25 The manager recently carried out a survey on the success of the key worker system, which indicated that it could be improved in some regards. Key worker tasks are now being explored in the regular staff appraisals, and residents are also being asked to comment on the effectiveness of the system. Service users written comments included that ‘staff are respectful’, ‘caring staff’, ‘friendly and efficient’, they ‘do everything well’. Relatives commented that their relatives ‘are treated with respect and kindness’, and that staff are ‘always polite’. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 26 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): 31,32,33,34,35,36,37,38 Quality in this outcome area is excellent. The home is well managed. The management takes a keen interest in maintaining a high standard of care and continuing to develop the service using regular audit and service user feedback. The health and safety and well being of service users, staff and visitors are supported by the day to day working practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 27 Many of the residents, relatives and staff praised the way the manager does her job. Residents felt she is accessible and approachable. Many residents and relatives gave examples of how they had been reassured or helped through difficulties. Staff described a very consultative, open management style, and said that they were clear about what was expected of them and felt well supported to achieve this. An audit team regularly looks at questionnaire responses and discusses how various aspects of the home could be improved. The team then draws up action plans. At present, the manager, the financial manager, and a member of care staff are on this team, but the manager intends asking some residents and some members of the domestic and catering staff to join. Relatives were invited but no one has yet volunteered. Servicing records were examined these included: The fire alarm system, this is tested on weekly basis with an annual service. The fire extinguishers were serviced on 17/01/07. The emergency lighting was last recorded as checked in 31.03.07, but was reported to have been checked in April. Fire drill records were seen for two dates in April 2007. Portable electrical Appliances had been checked in November 2006. The lift was serviced on 30.03/07 Hot water systems are tested and the temperatures are recorded. The baths, which have temperature controls fitted, were checked and safe ranges were recorded. Hoists were serviced in November 2006. Bed rails are checked individually. The COSHH (Control Of Substances Hazardous to Health) folder in the office contained information on the COSHH regulations and on safety data, as well as safety data sheets on the products in use around the home. Each product has been risk assessed and the level of risk clearly identified. Risk assessments were reviewed in March this year and have been marked as due for review again in March next year. Guidance on how to assess the risk rating was also included in this file. Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 28 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 3 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 4 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 3 3 3 2 3 Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP37 Good Practice Recommendations More care should be taken to ensure the staff computer screen is closed after use to ensure access is restricted to care plan records. Medication records are stored with the trolley in the dining room. This is a public area and is not safe storage this should be improved. Staff personal items are in the dining room, this is not the place for staff personal property and a risk assessment and review of storage should be made. OP37 OP38 Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@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. Extracts may not be used or reproduced without the express permission of CSCI Abbots Leigh Manor Nursing Home DS0000020295.V335663.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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