CARE HOMES FOR OLDER PEOPLE
Abbotsbury Mead End Biggleswade Beds SG18 8JU Lead Inspector
Dragan Cvejic Announced 17 June 2005 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 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 I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Abbotsbury Address Mead End Biggleswade Beds SG18 8JU 01767 313366 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (Bedfordshire) Ltd Colin Bunyan Care Home 32 (32) (32) (32) Category(ies) of OP - Older People registration, with number PD(E) - Physical Disability over 65 of places DE(E) - Dementia over 65 Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16/07/04 Brief Description of the Service: Abbotsbury is a purpose built home for older people. It is a part of BUPA’s Partnership Homes. The home is situated in a residential area of Biggleswade on the outskirts of the town centre. It is within walking distance of local shops and close to a local bus route. The A1 and main line railway allow easy access for those travelling to the home from a great distance. A car parking facility is also available on site for visitors and staff. The building is all on the ground floor and offers single occupancy for up to 32 service users including four respite care beds. All rooms are attractively decorated and personalised and have a 24- hour call system. The home has six day/quiet rooms and a smaller communal dining area. The home also has a large, enclosed garden. There is a local mobile library service, which calls at the home, and a hairdressing service is available on site. Support services are in place with a choice of general practitioners, and visits from the district nurses, chiropodist, dentist, and opticians. The community psychiatric nurse, occupational therapist, physiotherapist and dietician are accessed when required. A separate day centre is situated close to the home and a few service users from the home use this service. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out during one working day. The main methodology used was case tracking, but also other methods, such as document reading, direct observation, a pre-inspection questionnaire and also service users’ comments cards. The standard of care was good and the home worked hard to meet the requirements set on the previous inspection. The inspector spoke to the manager; tracked 3 service users’ cases, talked to 9 service users and 3 staff members. Visitors’ comments were used for this report, as well as 7 other comments cards. What the service does well:
A service user that has spent the last 14 years in the home provided valuable comments, comparing services now and in the past: “Things have changed a lot, some are much better and some are worse, but I don’t want to go anywhere else. I feel at home here. I get involved in care planning; I know how to complain if I wish. Staff look after me satisfactorily”. Another user commented: “I feel quite happy here. Since I came here about a year ago, they have met my needs. My key-worker discusses my care plan with me.” The manager stated that service users were very much involved in the life of the home; some even took part in a gardening project. Service users decided during one of their meetings to change the smoking policy; they are involved in planning their care and they choose the menu at their meetings with the chef and vote for small things such as having gravy served in jugs on the table rather than straight onto their plates. Training was good, varied and offered not only mandatory training but also the training related to users’ conditions, such as dementia. The NVQ was promoted and the home exceeded standards by training 75 of staff to the NVQ standard. Quality assurance was used to provide extra information about users’ satisfaction. The home carried out its own survey in addition to the one organised by BUPA. A visitor described the home and care: “It is lovely here. The garden is nice, that’s mum’s hanging basket”, he said proudly. “She has her own strawberries too. This is a good home.” Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 6 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 Prospective service users were given accurate and up to date information about the home to ensure they could choose based on information collected prior to admission. The home did not take service users whose needs exceeded the home’s ability to meet them. Thus the appropriateness of the placement was ensured. EVIDENCE: The Manager reviewed and updated the “statement of purpose” and “the service user’s guide” when changes occurred, such as the change of smoking policy. The needs assessment was done comprehensively, taking into account the information collected from social services and the home’s own assessment for which a detailed form was used. The home was clear of their abilities to meet the needs of service users and the manager showed how a service user was refused the place as the assessment indicated higher needs than the home could meet. The manager was aware of the home’s capabilities to care for certain medical conditions of service users. Recently a referred person was refused a place, as the home could not ensure that the assessed needs would be met.
Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 9 The home was regularly reviewing the needs of service users. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The home demonstrated through their records and the care process that the service users’ needs were met, and reassured service users that they would be well cared for. EVIDENCE: There was a clear connection between pre-admission details and assessments and the current care documents. The care plan was detailed, but pointed to the main areas of the assessed needs. The home’s own admission assessment form was used when it was necessary, in addition to standard assessment form. Care plans were reviewed regularly and up dated with changing needs. A risk assessment was drawn up parallel to the care plan and this reflected the risks identified in relation to care needs. The home promoted service users health care issues and engaged relevant professionals to fully meet the assessed needs. A new chiropodist was found and engaged. An ophthalmic service was also engaged for service users. The home took a step ahead of the standard requirements. They introduced a black board for service users with hearing impairments in order to clarify communication issues that were not absolutely clear in verbal form. This additional communication method helped the staff ensuring health care issues were appropriately assessed in the home rather than waiting and calling
Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 11 inappropriate professionals for initial assessment. Different charts, relevant to each individual were kept to ensure monitoring of the specific need and to easily identify a potential change. The home kept a separate “falls risk” assessment for those whose risk was assessed as high and this monitoring allowed the manager to analyse and act preventatively to reduce the number and consequences of falls. The home’s medication procedure ensured that the process was appropriate and records accurate. The home treated service users as individuals, privacy and dignity were respected. A service user, who is a light sleeper, requested that staff do not come in to check on her during the night. The home draws up a risk assessment and addressed this wish in care plan and ensured the wish was respected. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 The activities were seen as an important part of the care process and the home offered a variety that suited the needs of service users and regularly reviewed and searched for new activities to further improve provisions. The meal times, quality and quantity of food were discussed with service users and the home was constantly reviewing and improving this part of the service and provisions to the satisfaction of service users. EVIDENCE: The service users decided on their daily routine, either individually with their key-workers, or at their meetings. Several service users took part in a gardening project with some of the neighbours and a new paved patio area was made. The home expected a visit of an independent advocate that would widen the opportunities for service users to get involved into local community. The manager explained that the use of minibus from the neighbouring day centre was going to cease and the home’s response was to increase entertainment in the home. This process is on-going. Each staff member has a day allocated to them to decide on an activity of their choice in order to provide more options for service users. A visitor stated that he felt very welcome in the home on each occasion he visited his relative. Service user’s autonomy and choice were promoted and respected.
Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 13 The cook holds meetings with service users, where they could comment on catering arrangements, choice of food and any issues regarding this provision. This activity was highly valued in service users’ questionnaires during quality assurance survey. Menus were displayed on the tables in a dining room. The records regarding food were appropriate. Several service users kept a small amount of money with them, but the majority spoken to state that they were “happy” for the arrangements offered by BUPA and the financial procedure that was in place. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 A clear, simple and straight forward complaints procedure was displayed and was available for service users, visitors and staff to make complaints if they wish to. The home was doing everything possible to protect service users from abuse. EVIDENCE: The home had received three complaints. The Manager and the documentation confirmed the correct way of dealing with these complaints, one of these was partly substantiated and 2 were not upheld. The home responded within the set time scale. The manager explained the care and the actions that were taken to protect a service user who had left the home with relatives to move to another area, The Social services from the destination area were contacted and debriefed about the circumstances and concerns for the service user. The home does not hold service users money and they are encouraged and directed to summon help from families or professionals with their financial arrangements. There is an account that exists for those who want the home to help them and two of the service users use this, “BUPA’s financial systems”, their transactions were accurate and signed. The home initiated the “protection of Vulnerable Adults Procedure” in one case, this was to ensure the full protection of the service user and referred the case appropriately to another authority when the service user moved out of the area. The advocacy worker was expected to visit the following week to offer support and help to those that needed and wanted this independent input.
Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24, The home is located in a purpose built bungalow type building; it offers comfortable and pleasant accommodation to service users. It was well maintained and appropriate for the needs of current service users. The management ensured that, when new referrals were assessed, the environment was considered in relation to the conditions of the referrals. EVIDENCE: The location of the home was appropriate to the service users’ needs. Facilities and equipment in the home not only promoted service users’ independence, but allowed the choice, as in example recorded in individual care plans, where preferred bathrooms were recorded for each individual. The garden was much improved by the co-ordinated action of staff, service users, and members of families and local neighbours who all took part in the gardening project. A service user liked the project so much that she brought herself a reclining chair for the garden. Maintenance was organised at two levels, minor repairs were carried out by the maintenance man and major repairs by the contractors arranged through BUPA.
Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 16 New chairs and tables were bought for the dining room and a tumble drier was on order. The manager stated that any faults would be dealt with as they were reported. Shared areas in the home were evenly spread through units and were easily accessible even for service users with mobility problems and promoted independence. Service users decided on a new smoking policy and this decision was accepted and incorporated into the description of the home in the home’s brochure and service user’s guide. The bedrooms were individualised with pictures and some pieces of furniture that belonged to the service users, in addition to the provisions by the home, this helps to make their bedrooms more homely. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The home engaged an appropriate number of staff, with sufficient skills and experience to meet the needs of service users. EVIDENCE: Staff rota was clear. Any staff absences were covered by the engagement of the home’s own bank list of staff, this ensures consistency of care. The staff know their roles, expectations and tasks. Three staff files were randomly chosen and inspected and demonstrated that staff documentation was appropriate. Staff spoken to confirmed the training they received, as well as supervision, was appropriate. They commented on a “good staff atmosphere”. Staff were observed working with service users passing on a positivism and they even sang along with one service user. The Service users spoken to confirmed staff’s caring attitude and efforts to meet their needs. Training was up to date, and staff were very motivated to undertake the NVQ. Seventy five percent of staff achieved their NVQ, that exceeded standard requirements for 25 . This fact resulted in provision of better care, better ratio of qualified staff and to a good, professional atmosphere. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33, 35,36,37,38 In an open and inclusive atmosphere, the leadership skills from the manager and senior staff ensured a good quality of care in a safe and comfortable environment. EVIDENCE: The manager was skilled, experienced and qualified as required by the standards. He applied his leadership skills effectively that was seen from the staff and users’ comments. “ I get involved in my care planning”, said one user and the other added: “My key-worker comes to discuss my care plan with me”. When spoken to a key-worker, she confirmed: “We were instructed to discuss care plans with service users if they cannot be present on a care planning meetings.” The open management style reflected on the entire staff team and helped creating an inclusive and positive atmosphere. BUPA’s personal best programme was another motivating and encouraging factor that ensured that care offered to service users was of the high standard. Personal Best review
Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 19 done by a cook showed that service users preferred gravy served in a jag on the table rather than on the plates. This was discussed on their meeting and the minutes showed their decision to bring in the change how it was served. In addition to the company’s quality assurance, the home created their own questionnaires to obtain as many as possible suggestions from service users. This review was carried midway through the timescale for regular reviews. The frequency of the quality review meant that the home exceeded expectations about quality assurance system. These quality assurance reviews were used appropriately to analyse all aspects of the service and to address areas for improvements that had been consequently actioned. Service user’s money was appropriately dealt with by the policies and procedures in place. Staff were supervised regularly. Records were up to date and accurate, apart from mentioned service users property list. Safe working practices were in place, as accurate fire records, accurate records of accidents/incidents, training records and other relevant records in health and safety file demonstrated. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 4 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 x 3 x x STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 4 4 x 3 3 3 3 Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? 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 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. Refer to Standard 18 Good Practice Recommendations The home should keep an up to date and signed records of service users possessions in each service users file. Abbotsbury I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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 I51 s14873 ABBOTSBURY v226891 170605 stage 4.doc Version 1.30 Page 23 - 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!
