Inspection on 12/10/06 for Abbotsbury

This inspection was carried out on 12th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Abbotsbury 09/11/05

Abbotsbury 02/06/05

Abbotsbury 11/10/04

Abbotsbury 06/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Abbotsbury Abbotsbury H.E.P. Pettiver Crescent Hillmorton Rugby Warwickshire CV21 4JD Lead Inspector Jean Thomas Key Unannounced Inspection 12th October 2006 08:55 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 Abbotsbury DS0000041957.V311534.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. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsbury Address Abbotsbury H.E.P. Pettiver Crescent Hillmorton Rugby Warwickshire CV21 4JD 01788 565700 01788 551580 wandacicholaz@warwickshire.gov.uk 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) Warwickshire County Council, Social Services Department Mrs Wanda Cicholaz Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one person aged under 65 years who requires personal care and whose needs can be met by the home. 9th November 2005 Date of last inspection Brief Description of the Service: Abbotsbury is a Local Authority home for older people. It provides permanent care, short stays, day care and four beds for use by older people on a reenablement programme. The home is situated on a housing estate in the Rugby district of Hillmorton. There are local shops close by, and car parking spaces are available in front of the home. Abbotsbury provides accommodation on two floors, in four units, each of which has its own communal areas. Day care provision, which is not currently subject to inspection, is sited on the ground floor, together with the kitchen, laundry, staff offices and the hairdressing salon. On each floor, there are bathrooms and toilets suitable for people with physical disabilities. As well as the staircase, there is a passenger lift to the first floor. All the bedrooms have an en-suite lavatory and wash hand basin. The home is staffed over twenty-four hours. It has a management team comprising of a manager, assistant manager and four care officers. There is also a part time administrator. There are 27 care assistants providing day and night time care. The home employs two cooks, a kitchen assistant, three domestics, a laundry assistant and a helper part funded by the ’Sure Trust’ who helps to support employment for people with a learning disability. The daycare facility was staffed separately and not included in the number of staff employed to meet the needs of residents. Abbotsbury does not provide nursing care. Residents who require nursing attention receive this from the community nurse, as they would in their own homes. At the time of the inspection visit the fees charged by the local authority are in the range £27.30 - £380.24 per week and payable usually in advance by either cheque, direct debit or standing order. The fees do not include newspapers, toiletries, hairdressing or chiropody. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The inspection visit was unannounced and took place on Thursday October 12th 2006 commencing at 08.55am and concluding at 4.00pm. • • • • The inspection involved: Discussions with the registered manager, senior care officer, five care workers, laundry person and the cook. Observations at a mealtime. Two residents were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is known as ‘case tracking’ where evidence is matched to outcomes for residents. An inspection of the environment was undertaken, and records were sampled, including staff training, health and safety, staff rotas, complaints and fire records. The inspector spoke with four family members and two health care workers about their experiences of the home. • • The inspector had the opportunity to meet most of the residents and talked to three of them about their experience of the home. The residents were able to express their opinion of the service they received to the inspector. General conversation was held with other residents along with observation of working practices and staff interaction with residents. 34 questionnaire surveys were sent to residents and their relatives. At the time of writing the report, 13 residents and six relatives had responded. An audit of residents’ surveys showed satisfaction with the service provided, the residents knew who to speak to if they were unhappy, the home was always fresh and clean, the staff listen and act on what residents say and are available when residents’ need them. Comments noted include: ‘When I first moved in there was no TV in my room. I asked if I could have one as I was told in hospital there would be one. The members of staff who greeted me immediately went and got me a TV.’ ‘Couldn’t wish for better.’ ‘Came into respite previously so knew the home.’ Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 6 • ‘If I feel well enough I participate in activities, I am not obliged to join in I can please myself.’ An audit of relatives’ surveys showed that relatives were made to feel welcome when visiting the home and were kept informed of important matters affecting their relative. There were always sufficient numbers of staff on duty and they were satisfied with the overall standard provided. Since the last inspection on November 9th 2005, there were two complaints and one allegation of abuse made to the home. The first complaint was about a resident not having access to the hairdresser. The second was about a resident’s preferences not being taken into account. Following investigation, both complaints were upheld and were resolved to the residents’ satisfaction. The allegation of abuse was about the inappropriate behaviour of a member of staff who no longer worked at the home. The allegation was investigated in accordance with the local arrangements for the Protection of Vulnerable Adults (PoVA) and was partially upheld. In response appropriate action was taken by the manager to make sure residents health, safety and welfare was promoted and maintained. In addition, twenty letters or cards expressing gratitude for the standard of care provided for residents were also received by the home. One requirement made against the regulations was outstanding from the last inspection report. What the service does well: What has improved since the last inspection? Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 7 Improvements had been made in the way medication was managed and a clear audit trail showed that medication was administered as prescribed and details held of the circumstances when medicines known, as prn (to be given when necessary) should be given. The redecoration of five bedrooms and plans to redecorate a further four bedrooms and the communal lounge in the ’ Kensington unit’ as part of a programme of refurbishment further enhance the environment for residents. So that residents benefit from having their care needs met by sufficient numbers of qualified staff a further five carers had completed a National Vocational Qualification (NVQ) level 2 in care. One carer was working towards the award and completion was expected by the end of the year. 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. Abbotsbury DS0000041957.V311534.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 Abbotsbury DS0000041957.V311534.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Prospective residents are encouraged to visit the home before admission and an assessment of the individual’s care needs ensures the home will meet their needs. The assessment of residents requiring intermediate care also takes into account their personal circumstances and places emphasis on promoting independence to enable the individual to continue to live in their own home in the community. EVIDENCE: Before moving into the home, all prospective residents have their initial care needs assessed by social services and are encouraged to visit the home before deciding whether to move in. In addition, the registered manager or a senior care officer from the home visit prospective residents in their own home to assess their care needs and to provide information about the home. A record of the initial care needs Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 10 assessment was held and used to determine whether the residents care needs could be met. Three residents spoken with said they had been given the opportunity to visit the home before deciding whether to move in. One resident said they had chosen not to do so preferring instead to have family members visit on their behalf who then shared their views and opinions of the service. One resident spoken to said they visited the home on two separate occasions before deciding whether to move in. Comments noted in a resident questionnaire survey include: ‘I looked at three of your previous reports to this one. When seeing Abbotsbury I knew it was the one for me. The manageress made me feel very welcome.’ After an agreed trial period of four weeks, a review meeting with the prospective resident and their representative is held to determine whether the home is able to meet the needs of the prospective resident. As well as long-term care, a respite and intermediate care service is provided for those assessed as needing a short-term care service that aims to enable individuals to remain living in their own homes in the community. Two initial care needs assessments examined held information about the residents background; personal circumstances and care needs, including the residents abilities and limitations, what aspects of personal care they could manage themselves and what assistance was needed. The initial care needs assessment forms the basis of the residents care plan, which is recorded and agreed shortly after admission. The pre admission assessment format used for intermediate care differs from that of long-term residential care and places greater emphasis on reenablement and promoting independence. Abbotsbury DS0000041957.V311534.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. Residents are treated respectfully and their right to privacy generally maintained. The absence of accurate and detailed care plans and monitoring records place residents at risk of not having their care needs met. EVIDENCE: The personal profiles and care records of two residents identified for case tracking were read. The information held on the care plans varied and did not always provide the staff with the details they need to meet the residents care needs for example: A care plan identified the need to ‘manage continence’ by making sure the resident always wears a continence pad but failed to identify the need for regular toileting necessary for promoting continence and maintaining comfort and dignity. The care plan of a resident assessed as requiring assistance with personal care failed to identify what the resident could do for themselves and what practical Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 12 or emotional support was required to ensure needs were met and the residents independence promoted. The care plan of a resident whose low fluid intake was giving cause for concern identified the need for staff to ‘push fluid’ but failed to include the amount and frequency of fluids to be offered and the absence of accurate monitoring records may result in care needs not being met. Daily records read often failed to include what type of care and support had been given to residents, so it was not clear whether their needs were being met. One instance when care needs were not being met was identified. The care plan highlighted an underlying health care condition that required the staff to ensure the resident’s legs were elevated when sitting. Observations found the resident had not been given the assistance needed to elevate their legs and a footstool was not readily available. Although the absence of appropriate care was raised with a care worker, no action was taken to meet the residents health care needs. Two care plans required the night staff to carryout two hourly checks on each resident but failed to identify why the checks were necessary or whether residents had requested them. Individual checks on residents should be based on the individual needs and circumstances identified during consultation with residents or if appropriate, their representatives. The reason for carrying out night checks should be noted in the care plan and any checks carried out recorded on the daily records so that the home can be sure the care provided is as agreed on the care plan. Nutritional screening is carried out when the resident moves into the home and the outcome of regular weight checks recorded. Risk assessments for the prevention of pressure sores and moving and handling were in place and a risk assessment for the prevention of falls was held for a resident assessed as being ‘at risk of falls’. Examination of the care plans; daily records and other documentation found residents had regular access to GPs; community nurses; optician; chiropodist dentist and community psychiatric nurse. Two visiting health care professionals spoken with said regular visits were made to the home to carry out health care treatments such as wound dressings, insulin injections and the monitoring of a urinary catheter for signs of blockage. Comments made directly to the inspector include: • The level of care is excellent. • The residents are well cared for. • This is a very good home and the staff always follow any instructions. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 13 • The staff are kind, caring and welcoming and Ive never had any concerns. Advice about continence management was routinely sought from the community nurse who carried out the initial care assessment and care staff complete any monitoring forms provided by the community nurse. Residents assessed as needing continence aids or equipment i.e. pads or urinary catheters have these supplied by the Primary Care Trust (PCT). Residents requiring specialist equipment such as a pressure relieving mattress, cushion or hospital type bed have their needs assessed by the community nurse who also provides any equipment necessary to promote the health and well-being of the resident. The manager said none of the residents were being treated for pressure sores. A number of staff were spoken to and were able to demonstrate some knowledge and understanding of the individual needs of the residents in their care. Observations of staff practices found staff responded promptly and sensitively to the needs of residents. Examination of the storage, administration and handling of medication showed that medication was held and managed safely and securely and administered by suitably trained staff. For example, medication was held in a secure designated cupboard and was administered as prescribed. Temazepam tablets were held and administered as controlled medication and were therefore stored separately and two staff signatures secured confirming medication had been administered in accordance with approved procedures for the administration of controlled drugs. In response to shortfalls identified during the last inspection, the reason for administering medication known as prn (to be given when necessary) was recorded, for instance, Prochlorpromazine tablets were only to be given when the resident complained of feeling sick. A secure refrigerator was used to store medicines requiring cold storage, such as insulin. Records were held of the air temperature in the fridge, which was monitored regularly to make sure medication was stored according to the manufacturers instructions. The staff were observed treating residents respectfully. For example, personal care was provided in the privacy of the residents own room and staff knocked on residents’ doors before entering. Health care treatments provided by visiting health care professionals were not always provided in private; for instance, an insulin injection was administered to a resident in a communal lounge/dining area and with other residents close by. The manager said she was surprised this had happened as health care treatments were always provided in the privacy of the residents own room. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 14 Four residents spoken with said the staff were kind and respectful. Comments made directly to the inspector include: They are all lovely and nothing is too much trouble. I am very satisfied. Staff are always cheerful they brighten my day. They are always there when I need help. Residents appeared happy and comfortable in the home and with the people supporting them. Abbotsbury DS0000041957.V311534.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Residents can choose how and where to spend their time and are encouraged to continue with any hobbies or interests. Visiting is flexible and takes into account the needs and wishes of residents. Some activities are available for those choosing to participate and residents benefit from having a balanced and nutritious diet. EVIDENCE: The home had an open visiting policy, which takes into account the individual needs and wishes of residents. Four visitors spoken to confirmed visiting was flexible and they were always made to feel welcome. Two visitors said they were regularly offered a cup of tea or coffee and they felt comfortable when visiting their relative. Staff kept them up to date with any changes in their relative’s condition or care needs. Visitors were observed visiting their relative in the privacy of their own room or in communal areas of the home. There was a basic activities programme in place and residents had access to the range of additional activities provided by the staff in the day-care facility. The manager said residents were encouraged to participate in activities. Three residents spoken to said they were satisfied with the activities available which include: exercise therapy; sing along, a visiting library and board games. One Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 16 resident said she enjoyed knitting and did not often participate in other activities. Two residents said they enjoyed playing bingo and one said he enjoyed reading his daily newspaper. The hobbies and interests of residents were recorded in their care profile but daily records examined failed to identify whether residents actively pursued any of the hobbies or interests recorded in the care plan. All of the residents spoken to said they could choose how and where to spend their time. Comments on a resident survey questionnaire include: ‘I generally prefer to be alone as this is most important to me.’ ‘Dont like activities prefer to watch television.’ ‘If I feel well enough I participate in activities, are not obliged to join in I can please myself.’ The spiritual needs of residents were addressed by a visiting minister from the local church (St Mathews) who used to visit each month, but due to lack of attendance by residents now only visits occasionally or upon request. The kitchen was clean and well managed, a record of fridge, freezer and high risk cooked food temperatures were held and regularly maintained. A cleaning schedule was in place and used to make sure all areas of the kitchen were regularly cleaned and well maintained. Food storage areas were well stocked with a wide range of fresh and frozen foods. The manager said all staff that handle food were trained in basic food safety and had completed training in Hazard Analysis Critical Control Points (HACCP). The home is divided into four separate units each with its own communal lounge and dining area. Most residents have their meals at the dining table and others preferred to eat in their room. Menus were displayed and residents consulted each day to determine their preferences. The menus were varied and offered residents a nutritious and balanced diet. Fresh fruit was readily available in communal lounge and dining areas. Residents were offered alternatives and could help themselves to the food on the table, which was attractively presented in vegetable dishes. This is to be commended. On the day of the visit residents enjoyed lamb chops, mint sauce, roast potatoes, cabbage, carrots or mild chicken curry and rice followed by a fruit tart or fruit flan with topping. The staff were readily available and provided any support or assistance needed. Four residents spoken to were all enthusiastic about the food. Comments made directly to the inspector include: • I love the food. • I am very satisfied with the food. • I look forward to my meals. Abbotsbury DS0000041957.V311534.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. The home has appropriate policies and procedures for the protection of residents and complaints are listened to and taken seriously. EVIDENCE: The home has a complaints policy and procedure details of which are displayed in the home. Since the last inspection on November 9th 2005, there were two complaints and one allegation of abuse made to the home. The first complaint was about a resident who on one occasion was denied access to the hairdresser. The second was about the staff not taking into account a resident’s care needs when assisting with personal care. Following investigation, both complaints were upheld and resolved to the complainant’s satisfaction. The allegation of abuse was about the inappropriate behaviour of a member of staff who no longer worked at the home. The allegation was investigated in accordance with the local arrangements for the Protection of Vulnerable Adults (PoVA) and was partially upheld. In response appropriate action was taken by the manager to make sure residents’ health, safety and welfare was promoted and maintained. Three residents spoken to were not aware of the complaints procedure but said they would raise any issues with the manager if dissatisfied with any aspect of the service. All the residents spoken to had never had cause to complain. Comments noted on one questionnaire survey include: Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 18 I would like it to be noted that the complaint was dealt with in the utmost professionalism with care for my mothers feelings and was completed with a very satisfactory outcome. Appropriate policies and procedures were in place to protect residents. The manager was aware of the local arrangements for the Protection of Vulnerable Adults (PoVA). Four staff spoken with said they had attended training in recognising and responding to any allegation of abuse and would report any concerns to the manager. Two of the four staff spoken to were aware of the ‘whistle blowing’ policy and procedure which was included as part of the training for a National Vocational Qualification (NVQ). Examination of staff training records confirmed that a number of staff had attended training in adult protection and that further training was planned. Abbotsbury DS0000041957.V311534.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21,22,23,24,25 and 26 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Residents live in a generally well-maintained and safe environment that is equipped to meet their individual needs. Residents are able to personalise their rooms and benefit from living in a home that is clean and free of offensive odours. EVIDENCE: A tour of the premises found the environment was generally well maintained. All areas of the home seen were clean, bright and airy and free of offensive odours. In response to shortfalls identified during the last inspection five bedrooms had been redecorated as part of an ongoing programme of refurbishment. A further four bedrooms and a communal lounge had been identified for the next phase of the ongoing refurbishment programme. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 20 Residents were encouraged to personalise their rooms and some had brought small items of furniture into the home with them. Three residents spoken to said they were satisfied with the accommodation and were very comfortable. The manager said an inventory of personal items brought into the home was recorded at the time of admission. Two residents invited the inspector into their rooms, which were of a reasonable size and accessible for wheelchairs. Each room held a range of personal items including an armchair, photographs, ornaments, flowers, pictures hanging on the wall and in one instance a bowl of fresh fruit and a small refrigerator used for storing cold drinks. All bedrooms had an ensuite toilet and wash hand basin and a locked draw in which to hold medication, (if the resident wished to self medicate on completion of the necessary risk assessment), or money if they chose to manage their finances. A tour of the premises found that adaptations and equipment had been provided to meet the assessed needs of the residents. These included handrails fitted along the corridors, grab rails in the toilets, access ramps and a lift for wheelchair users. There were also hoists, variable height beds and a staff call system. The home had five assisted bathing facilities, one of which was an assisted shower. There were sufficient toilets in the communal areas and a separate sluice facility on each floor. Laundry facilities were inspected and found to be well organised, clean and hygienic. Soiled laundry was held separately in red bags and washed at the appropriate hot water temperatures to ensure it was thoroughly clean and to control the risk of infection. Hand washing facilities and disposable gloves were available and the storage area for laundered linen and clothes were tidy and clean. When asked about the quality of the laundry service three residents said their clothes were returned promptly and they were satisfied with the service. One visitor spoken to said she laundered her mothers clothes at home. All the residents seen were smart in their appearance, with clothes looking fresh and clean. Staff wore suitable protective clothing when carrying out personal care tasks, health care treatments or when handling soiled laundry. Safe systems were in place for the safe management of domestic and clinical waste. Liquid soap and paper hand towels were available in the toilets and each floor had a sluice facility used by staff to clean commodes. Staff training records confirmed the staff were trained in the control and prevention of infection. Abbotsbury DS0000041957.V311534.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Residents’ have their care needs met by appropriate numbers of trained and experienced staff. Rigorous staff recruitment procedures promote the safety of residents. EVIDENCE: At the time of the inspection there were 28 residents and a staff compliment comprising of the registered manager, assistant manager, four care officers, 27 care assistants, administrator, three domestic assistants, two cooks, a laundry person and one helper part funded by the ‘Sure Trust’ an organisation that helps to support employment for people with a learning disability. The day-care facility was staffed separately and not included in the number of staff employed to meet the needs of residents. On the day of the inspection, each of the four units was staffed with one care assistant and a further two care staff were working between the four units to provided any additional support needed. There were two domestic assistants, a cook, laundry person and administrator. A senior care officer supported the manager. Examination of four weeks staff rotas showed there were generally sufficient numbers of experienced staff available to meet the needs of residents and regular relief carers employed by the home filled any gaps. The rotas identified a number of staff vacancies i.e. five day care assistants and one Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 22 night care assistant. The manager said she was waiting for the outcome of Criminal Record Bureau (CRB) disclosures and checks made against the Protection of Vulnerable Adult (PoVA) register to determine the fitness of three prospective employees before they start to work at the home. Four relatives and three residents spoken to all said there were sufficient numbers of staff available to meet the needs of residents. An audit of questionnaire surveys completed by residents found that staff were available when residents needed them. The number of qualified care staff meet the minimum standard expected. For example, of the 31 care staff employed, 15 had completed an NVQ 2 in care, one was working towards achieving the award and four carers had completed NVQ 3. The manager and assistant manager are NVQ assessors and expect all care staff to complete the award so that residents benefit from having their care needs met by qualified care staff. Staff training records show the staff had access to a wide range of training and development opportunities, for example: continence awareness, dementia care, health surveillance, foundation principles of care and foot care. A number of staff had also attended training in anti discriminatory practise and ageism awareness. This is to be commended. Records also show staff attend regular training updates. Three care staff spoken with confirmed they attended regular training and were keen to explore any opportunities made available to them. One carer said she had completed NVQ 2 in care and would now like to progress to NVQ 3. The personnel files of two recently appointed staff were examined and these contained all the necessary information and pre-employment checks necessary to determine fitness such as, previous work history, references, Criminal Record Bureau (CRB) disclosures and checks made against the Protection of Vulnerable Adults register (PoVA). New staff have an induction relevant to their role and responsibilities that includes shadowing an experienced worker and training in health and safety, safe moving and handling techniques and the principles of care. Staff training records confirmed regular updates in a range of health and safety issues and moving and handling. Abbotsbury DS0000041957.V311534.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35,36 and 38 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. The home is well managed and has systems in place to promote the health and welfare of residents who also benefit from having their needs met by staff who are supervised. Quality assurance monitoring is implemented as a core management tool and any shortfalls in the service addressed. EVIDENCE: The manager is a qualified social worker registered with the General Social Care Council (GSCC) and has completed the Registered Manager’s Award (RMA). The manager is experienced and continues to update her learning, for example, training completed since the last inspection includes: first aid at work, equality and diversity and managing performance. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 24 Most of the residents spoken to knew the manager and said she was available and approachable. Four relatives and two health care professionals spoken to said the home was well managed and welcoming. Three staff spoken to said residents were well cared for and the home was described as “a good place to work.” The staff felt they could discuss any work related issues with the manager who “always finds time to listen.” Formal one to one staff supervision was carried out and used as part of the normal management process to monitor care practices delivered by staff, which ensures that residents’ health, safety and welfare is maintained at all times. A quality survey was carried out in October 2005 by an independent organisation (Age Concern) whose representatives visited the home and asked the long stay residents about the service they received. Individual questionnaires were completed during consultation with each resident and the outcome of an audit of responses sent to the home. Plans are underway for a further quality survey to take place later in the year. The findings of the quality audit were read and showed a high level of service satisfaction. This years quality audit is to be further developed to include the experiences of short stay and intermediate care residents. The manager said the outcome of the quality audit had been reported back to residents at one of their meetings. Minutes held of residents meetings confirmed this occurred. Since the last inspection, the home had received a significant number of compliments and commendations, which were held in the home’s ‘complaints, comments and compliments’ book. Questionnaire surveys received by the commission all contained positive comments such as thankful for the care given to me and quite happy here.” Regular visits by the registered person or their representative to monitor the service were not being implemented as required by the Care Home Regulations 2001. This shortfall remains outstanding from the last inspection and must be addressed so that we can be sure the service is being regularly monitored and the health, safety and welfare of residents protected. The home had a policy and procedure for safeguarding residents finances. Monies held for safekeeping were stored safely and securely. Records of all financial transactions were available and individual receipts held for items and services purchased on behalf of the residents’. In response to a shortfall identified during the last inspection, monies held on behalf of residents were no longer pooled and were held separately in named envelopes. The manager said family members supported a number of residents to manage their finances and nine residents were subject to Power of Attorney. Information about how to access an independent advocacy service was displayed in the Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 25 home. At the time of the inspection there was no property being held for safekeeping. Tests for Legionella had been undertaken and regular checks on portable electrical appliances, electrical and gas systems and the passenger lift carried out. Examination of health and safety records showed weekly tests on the fire alarm and fire doors and that a new fire risk assessment had been carried out. Records were held of staff attending fire drills and the manager said the fire safety officer visited twice a year and provided staff training to make sure everyone in the home was safe. The most recent Environmental Health Officer (EHO) visit took place in June 2006 and repairs identified during the visit completed. Accident records were held and staff training records showed that 34 staff held a current first aid certificate. Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 26 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 27 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 Requirement The registered person must ensure care plans contain sufficient detail to enable staff to complete the required action to meet the individual care needs of service users. The registered person must ensure that were there are concerns that service users fluid intake is insufficient to meet their needs accurate monitoring records must be held and accurately maintained. The registered person must ensure service users’ identified care needs are met. The registered person must make suitable arrangements to ensure that the home is conducted in a manner, which respects the privacy and dignity of service users. The registered person or delegated person must visit the home monthly and write a report upon the conduct of the care home. A copy of this report must be available for inspection. DS0000041957.V311534.R01.S.doc Timescale for action 31/10/06 2. OP10 12(4) 31/10/06 3. OP33 26 06/11/06 Abbotsbury Version 5.2 Page 28 (Part met – Outstanding from 02/06/05) 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 OP7 Good Practice Recommendations The need for night checks on service users should be based on the individual’s needs and circumstances and agreed with the service user, and or if appropriate, their representatives. The reason for carrying out individual night checks on each resident should be included in the care plan and any checks carried out recorded on the daily records. Daily recording should include how residents spend their time. 2. OP12 Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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 Abbotsbury DS0000041957.V311534.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!