Inspection on 17/05/07 for Abbotsbury

This inspection was carried out on 17th May 2007.

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 01/11/07

Abbotsbury 22/02/07

Abbotsbury 02/05/06

Abbotsbury 09/11/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Abbotsbury 25 Park Road Southport Merseyside PR9 9JL Lead Inspector Elaine Stoddart Key Unannounced Inspection 17th May 2007 09:00 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 Abbotsbury DS0000065441.V340600.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 DS0000065441.V340600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsbury Address 25 Park Road Southport Merseyside PR9 9JL 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) 01704 537117 0870 762 8881 Ramos Healthcare Limited vacant post Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 22nd February 2007 Date of last inspection Brief Description of the Service: Abbottsbury is a care home providing accommodation for up 21 older people who need personal care and support. Ramos Health Care own the home. A new manager is now employed who is yet to be registered with the Commission. The home is situated in a quiet residential area not too far from the centre of Southport and its amenities. It is within easy reach of the local park and public transport. The home is a large detached 3-storey building with 19 single rooms and 1 double. There is a large well-kept garden to the rear and side of the property and parking at the front. The home is well maintained internally and externally with good quality furniture and fittings. There is a passenger lift servicing all floors. The current rate of charges is £360.00 - £370.00 per week. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected. A pharmacy inspector accompanied the inspector during the visit to inspect medication practices. This key inspection was conducted following a management review of the service on 9th April 2007. The last key inspection took place on the 22nd and 26th of February 2007 and a number of requirements were made to improve the service within set times scales. This key inspection was made to monitor the progress of the home in meeting those requirements and to investigate an anonymous complaint, which was received by the Commission regarding weekend staffing levels. All the key standards were assessed during this key inspection. A tour of the building was conducted. A selection of care staff and home records were also viewed. The manager, Carole Dacre, a representative of Ramos Health Care, Audrey Tan, deputy manager, Elaine Green, two care staff and four of the fourteen residents were spoken with and their views obtained of the home. Satisfaction comment cards were given to residents prior to this inspection. Comments received during the visit and those from surveys received are contained within this report. What the service does well: The home provides clean and comfortable accommodation. There was a pleasant atmosphere and relatives and staff were observed to interact well with the residents. Some positive comments were received from residents spoken with and surveys received. “Happy as I am”. Resident. “Home is decorated well, clean and comfortable”. Relative “The home is always clean and fresh”. Resident “Care staff are helpful and kind”. Relative “The staff always listen to me” Resident Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The new manager has made progress and has met some of the requirements issued at the last inspection. The immediate requirement made by the pharmacist in February 2007 has been met. Residents spoken with were expressed their confidence in the new manager and hope that she will continue to improve the service. “Carol the manager is doing as much as she can”. Resident. “New manager is smashing. On the ball”. Resident There are still requirements outstanding and these are contained in the section “What they could do better” and highlighted in the requirements of this report for action. Two of the three outstanding requirements are still within the time scale and the manager confirmed these will be met within the dates. The manager is very committed to improving the standards provided, is qualified and experienced in caring for the elderly. Since the last visit improvements have been made in medication administration. Staff are now trained in this area. All care staff are now responsible for keeping daily up to date records of care provided. Records are more organised and care files are more detailed and are securely stored. Residents’ health care records are kept and recorded daily by care staff. Residents’ daily activities are now recorded in their care plans. A staff-training plan is in place and staff have received training in infection control. Training in food hygiene is planned for June 2007. Policies and procedures are being updated and staff are provided with ‘A policy of the week’ and sign to acknowledge their understanding. A new induction process is in place for new staff and the manager monitors their competency. Some rooms have been re decorated and some rooms are being improved to provide en suite facilities. A repairs/maintenance book records repairs needed Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 7 and action taken. The home has developed an improvement plan. Not all private rooms have locks and the home has recorded residents’ consent that they don’t wish to have one. Staff meetings have been taking place to consult with staff on the changes made and their responsibilities. There had been improvement to the way medicines were ordered, recorded and administered helping to ensure medicine is administered as prescribed. What they could do better: The manager has made progress to meet the requirements of the last inspection. The requirement made in February 2007 regarding weekend staffing levels has not been met and the manager/provider must provide sufficient staff on duty at weekends to meet the needs of the residents. An anonymous complaint was also received regarding this issue and investigated during the inspection. Insufficient staffing levels at weekends were found and a further requirement made. This was discussed with the manager and owner during the visit. The manager should continue to monitor hours worked by those staff who work at other homes to ensure that excessive hours are not worked. A core group of regular staff should be employed to avoid using staff who are not familiar with the residents needs. Staff who have left the service must not be employed at the home without going through the necessary recruitment and selection procedures. An up to date file on this information must be kept at the home for ‘bank’ staff who are called upon when needed for sickness/holiday cover. To equip the staff with the skills to carry out their roles, the manager must continue the training plan for all staff, including National Vocational qualifications (NVQ) and abuse training. At the time of the inspection one of the twelve care staff are qualified in NVQ. The home should aim to meet the National minimum Standard of 50 . The home should provide a temporary cook to cover during the permanent cooks absence to avoid care staff having to cover, which results in a reduction of staffing levels. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 8 The manager should continue to develop a Key Worker system to involve care staff in responsibilities and accountability at the home. The manager must make an application to be appointed as registered manager by CSCI. The manager should develop quality-monitoring systems to obtain feedback from residents, visitors and other professionals on the service provided. The provider should conduct regulation 26 visits and complete a report on the quality of the service and a record of this report made accessible for the inspector to view. The manager should arrange resident/relative meetings to inform them of progress and provide regular supervision for care staff to keep them involved with the changes and developments. The complaint records maintained should demonstrate the comments/grumbles made regarding the service and the outcomes. Residents’ monies must not be ‘pooled’ within the homes account. A separate ‘personal allowances’ account must be used for each resident, receipts obtained and records for all transactions made. When residents accumulate monies within their personal allowance account the resident/families must be encouraged to open a post office/or bank account. The home should continue to improve and aim to promote the service to encourage prospective residents and raise occupancy levels. 14 residents were accommodated at the time of the visit. The home is registered for 21. 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 Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 9 be made available in other formats on request. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 10 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 DS0000065441.V340600.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information on the service and have the opportunity to visit the home. Assessments are completed prior to admission. Standard 6, intermediate care is not provided. EVIDENCE: No new residents have been admitted since the last inspection. Fourteen residents were accommodated at the time of the visit. A statement of purpose is in place and the home aims to develop a simple but informative brochure to be provided to enquirers. A copy of the most recent inspection report is available to view. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 12 Three care files viewed showed assessments had been completed in sufficient detail. The manager has made progress since the last inspection to provide the information in an organised and detailed manner. Residents’ files contained all information on the residents daily living needs, photo ID, admission details, social history and likes and dislikes. The assessment then forms the basis of the care plan, which is reviewed monthly and contained information on – mental state, communication, diet, mobility, interests, sexuality, sleep arrangements and personal care needs. Manual handling and risk assessments are completed. All reviews undertaken with other professionals are contained in the residents file. Contracts are now in place and are signed by the resident/or relative. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans and information on residents care needs have improved to demonstrate care delivered and involve residents and relatives. Access is available to health care professionals and is recorded. Residents’ rights to privacy are upheld. Medication is administered safely and staff are trained. EVIDENCE: Three care files viewed demonstrated the manager has made considerable progress in obtaining detailed information on the residents care needs. This information is fully contained in their care needs assessment and this is then used to form their detailed plan of care. All care needs were identified and recorded, reviewed monthly by the manager to reflect changing needs. The manager has involved the care staff in this process and daily records on Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 14 residents care needs are recorded in daily reports and the handover book to ensure the needs of residents are monitored and recorded. All health care visits are recorded and this was evidenced in the three care files viewed. Visits by GP, DN, chiropodist, blood tests, and urine tests taken are recorded. Residents spoken with confirmed their health care needs are being met. A resident’s emergency file has been developed to ensure that should they be admitted to hospital the correct information goes with them, such as medication and care needs. All personal care given is recorded and weights are completed monthly. The laundry system was found to be more organised and a labelling system is in place. The manager hopes to improve the system further by the introduction of key workers who will be responsible for a number of residents and will itemise their clothing and avoid losses. At the time of the visit two care staff had rung in sick and the home had to provide cover by two care staff from one of their other homes. The care staff had not worked at this home previously. The deputy manager was on duty to assist with information on residents care needs. The manager came on duty as she was informed of the inspection and one of the owners was present. Staff were observed to treat residents with respect and knocked on private rooms prior to entering. Staff were observed to interact with the residents during the day. 17/05/07 – Pharmacist. The manager had re-written the medication policy to ensure there was clear guidance for staff about the handling of medicines in the home. But, there was no written information for staff about what they should do if they made a mistake when administering medication. This should be included in the policy to make sure the right action is taken if a mistake is made. All staff handling medicines had completed certificated training. And, the acting manager explained that she had observed staff whilst they were administering medicines and asked them questions to help ensure they understood what to do. The way that medicines were ordered had improved reducing the risk that medicines will ‘run out’. The storage was clean and organised making it easier to find and check residents’ medicines. There were two unlabelled medicines in the ‘stock’ trolley; these should be promptly retuned to the pharmacy for destruction because it was not possible to tell whom they were for. Residents who wish to self-administer medication were supported to do so safely, but most medicines were administered by care staff. Although Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 15 medicines were not regularly given at night, the manager said night staff were trained to administer medicines if needed. One resident said she worried that one of her tablets would not be administered at the right time and was wondering whether it would be better for her to be given it weekly to self-administer. The manager said that one member of staff hadn’t known that the tablet needed to be given first thing and it had been missed, but all staff knew now. The worries should be discussed with the resident. If self-administration were preferred an assessment would need to be completed to make sure any support needed to safely self-administer was provided. The medication record keeping had improved. The administration records were clearer and no longer listed ‘stopped’ medicines making them easier for staff to use when administering medication and reducing the risk of mistakes. One infrequently used ‘when required’ medicine was not listed on the administration record. Another resident was prescribed a tablet ‘one or two when required’ staff administered all the resident’s tablets but there was no guidance for them about how or when this should be given. All medicines should be listed in case they are needed. Information about the use of ‘when required’ medicines should be recorded to enable staff to support their correct use. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily life and routine in the home is flexible to suit individual needs. Residents have an appealing balanced diet are able to maintain contact with family and friends. EVIDENCE: At the time of the visit the regular cook was absent on sick leave. The home had not employed a temporary cook and the deputy manager was undertaking the cooking. The main meal is served at lunchtime and staff were observed to assist were necessary. The home provides a flexible approach to meals and residents are able to have their meals in their own rooms should they wish. Drinks and snacks are available throughout the day and staff were seen to provide these to residents. Alternatives are available and residents spoken with confirmed this. Fridge and freezer temperatures records had been completed. The home is completing evidence for safer food better business. A recent inspection by the Environmental health Department on 31/1/07 resulted a good report. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 17 Food stores were well stocked with quality products and supplies were being delivered at the time of the visit. The main meal consisted of fresh chicken; fresh vegetables and apple crumble for desert. The main meal served was nutritious, in sufficient supply and the residents said they enjoyed it. Staff came around with ‘seconds’ for the residents. Differing comments were received from the residents interviewed on the meals provided: “The food is not good enough. There isn’t enough” “The meals are good we get plenty. You can have what you want”. Discussion with the manager and owner took place regarding the absence of the cook who is due to return in two weeks. It was recommended that a temporary cook should be employed during her absence following the correct recruitment and selection procedures. This will enable care staff to carry out caring duties to meet the needs of the residents. The home provides activities in the form of quizzes and entertainers. The activity programme for May was seen and included exercises, home cinema, quizzes and nails sessions. Residents are able to choose if they wish to join in. One resident commented, “I don’t like to join in” and his choice is respected. A record is kept of the residents who take part. Residents interviewed and surveys received commented they are satisfied with the activities in place and they can join in if they wish. A hairdresser attends weekly. There were no visitors to speak to at the time of the visit, however residents interviewed confirmed that their visitors are made welcome at all times and often call in daily. Residents are able to receive visitors in private in their own rooms or in the communal areas. All rooms were viewed, contained personal possessions and were found to be comfortable and clean. The residents spoken with were satisfied with the accommodation. One resident said he had requested a larger room and this is being dealt with by the manager. This was discussed with the manager who is aware of the request. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware of how to make a complaint. An abuse policy and procedure is in place and in house abuse training has being provided to ensure staff are aware of the procedures EVIDENCE: An anonymous complaint had been received prior to the visit regarding weekend staffing levels. This was investigated during the visit. A survey received requested to register an official complaint regarding missing residents clothing. The provider has been requested to investigate this using the home’s complaints procedure and reply to the complainant. The home had not recorded any complaints since the last inspection. However discussion with the manager confirmed she had had a ‘concern’ from a relative regarding staffing levels one Sunday. There was a staff shortage due a a carer being sick during the morning and another carer agreed to cover for her. This left insufficient care staff on duty. The manager confirmed she has sproken with the members of staff involved regarding the incident. The manager was informed that all concerns, grumbles, comments are to be recorded and that staff do not let this happen again. A recommendation is made within this report. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 19 Complaints procedures are displayed in the hallway. The abuse /whistle blowing policies have been updated and made available to staff in the ‘policy of the week’ and staff sign to acknowledge this. A copy of ‘Safeguarding Adults’ is available to staff and the home has learnt from past adult protection issues and are confident they are now aware of the correct procedures for alerting, who will investigate and advise. The manager confirmed that abuse training for staff is to continue over the next twelve months. Some staff have received this and training records confirmed this. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, well-maintained, clean and hygienic environment. EVIDENCE: Since the last visit the home has developed a refurbishment plan, introduced a new health and safety policy and health and safety training for staff. All areas were viewed during this inspection. Rooms were found to be comfortably furnished and clean and contained personal items. Risk assessments are completed for all radiators without covers. Since the last visit the home has been making alterations to two rooms to provide en suite services. A number of rooms have also been decorated when vacant ready for the next resident. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 21 The home employs a maintenance person to deal with day-to-day repairs and a repairs book records any repairs required and action taken. Monthly room audits are undertaken to check on repairs. The grounds are kept tidy. Access to the premises is via a ramp then two steps at the front door. The last Occupational Therapist report was made on the premises on 12/11/04 and recommendations made. A fire risk assessment was completed in February 2007. The dining room is pleasant and tables set with napkins. The majority of the residents spoken with were satisfied with the accommodation and standards of the home. One resident said, “The toilets are often not clean. Staff don’t check them enough”. Surveys received said, “Home is decorated well, clean and comfortable”. (Relative) “The home is always clean and fresh”. (Resident). One resident said he had requested a larger room and is in the process of moving into a vacant room. This was discussed with the owner/manager who is aware of this. The domestic help was on holiday and the owner and a carer were doing the cleaning during the visit. There are sufficient bathrooms and toilet facilities in place for the residents. The laundry is equipped with a sluice facility, washer and tumble dryer. Hand washing facilities and COSHH procedures are in place. A paper towel system in the laundry and all communal areas would be beneficial. Plenty of aprons and gloves are supplied to avoid cross infection. A labelling system is being organised to avoid laundry going missing. Key workers are to be responsible for this. There is a large separate drying room for residents clothing. A complaint made was regarding residents clothing going missing and is being investigated by the provider. Equipment is in place for those with difficulty in bathing and toileting in the form of raised toilet seats and assisted bath. The hoist has a full service certificate. Call systems are in place throughout the home. Not all private rooms have locks and the home has obtained the residents consent if they don’t wish to have one. Bed side bumpers are provided were these are used. The home was found to be warm, ventilated, comfortable and clean. Certificates for all services i.e. gas are up to date. Residents were observed to be comfortable in their surroundings and accessed all areas of the building. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 22 All services, such as Gas, electricity have up to date certificates in place. Abbotsbury DS0000065441.V340600.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): Standards 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels fail to meet the needs of the residents. Staff are receiving an ongoing training programme and the home should aim to meet 50 of the staff qualified in NVQ. EVIDENCE: At the time of the inspection two care staff had rang in sick and this had resulted in two care staff from another of the providers’ homes providing cover. Neither of these staff had worked at the home previously. The deputy manager was cooking, due to the absence of the regular cook who is on sick leave. The domestic was on her holidays and the owner was conducting the domestic duties. The manager, who was on holiday, came in to be available for the inspection. The deputy manager called a previous member of staff, who left the service in February 2007, to come into assist. She is no longer on the homes employment list. An anonymous complaint had been received regarding the insufficient staffing levels at weekends. Duty rotas viewed showed insufficient staffing levels during the weekend. This was raised as a requirement at the last inspection Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 24 and was not met. Discussion with the manager and owner confirmed that there are two carers on duty at weekends, none who are in a senior position. The manager is presently covering Saturdays. The weekend cook has left and care staff are having to cook the weekend meals. Discussion with the manager and owner took place regarding - The lack of staff employed in the home to cover for such absences, who know the residents needs. The lack of a cook and care staff having to cover this. Insufficient senior care staff on duty on Sundays. Insufficient levels of staff place residents at risk. One resident requires two carers to transfer. Ex care staff are being asked to cover when they have left the home. The home must re recruit these staff as ‘bank’ staff should this need to use them and complete all recruitment and selection procedures. Staffing levels have been reduced since the reduction in residents to fourteen. The manager must ensure that staffing levels are raised as new residents are admitted. The manager confirmed she is monitoring dependency levels. The duty rota must show a true picture of the staff on duty including carers, management, domestics and cooks. A number of staff are employed at the home who also work at other homes within the Ramos Health Care Group. Discussion took place with the manager who should be aware that they are not working excessive hours and do not do double shifts. This is to ensure they are capable of fulfilling their duties. The inspector spoke with the deputy manager who confirmed that staffing levels are a Concern. She commented she is very happy with the new manager and believes that the home will improve with her guidance and support. Only one member of the care staff has an NVQ qualification. This was discussed with the manager and owner. The home should continue this to meet the National Minimum standard of 50 care staff qualified with NVQ. The manager confirmed that all new staff are employed using the correct procedures. And records viewed confirmed this. These include an up to date Criminal Record Bureau check (CRB) and two written references. The manager is recruiting new staff and has updated all staff files to ensure they contain the correct information – application, interview, induction, CRB, references and contracts. Since the last inspection the manager has made progress to meet the requirements made and has been obtaining up to date CRB’s and references for staff who failed to have these. The new manager confirmed at the visit she has introduced a new induction process for staff, which she signs of once staff competency has been assessed. Regular supervision and appraisals are yet to be implemented. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 25 Progress has been made to ensure staff are trained in the statutory training. Recent training has taken place on fire safety and training is booked for Infection control (using a distance learning package) and food hygiene is booked for June. A list of staff who have completed training and who still requires it is in place. The manager is to ensure that the training programme is ongoing. Training in dementia care and challenging behaviour is to take place on 5/6/07 and 26/6/07. Some staff have completed abuse training and further training is to be arranged. The manager said she gone through abuse procedures with all staff ‘in house’ to confirm their understanding. A new abuse policy and procedure is in place and staff sign to acknowledge. The inspector was unable to talk to other carers as the regular carers were off sick. Comments received from residents spoken with and surveys received regarding the staff and management. “Not enough staff on duty”. Resident. “Never know which staff are on. I have never seen the two staff before who are on duty”. Resident “Carol the manager is doing as much as she can”. Resident. “Care staff are helpful and kind. Appears to be low levels of staff”. Relative “New manager is smashing. On the ball”. Resident. “The staff always listen to me” Resident The staff were observed to interact well with the residents at all times and were attentive to their needs. A pleasant atmosphere was present. Abbotsbury DS0000065441.V340600.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): Standards 31,32,33,34,35,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from the introduction of a new manager who is committed to making progress with the involvement of residents, staff and other interested parties. The manager is yet to be registered. Policies and procedures are in the process of being updated. Residents’ finances must be safeguarded. EVIDENCE: Since the last inspection the new manager has made progress in meeting the requirements. She has made progress in organising training, arranging meetings, organising staff files, using the correct recruitment procedures, organising records, care plans, introducing new policies and procedures and daily records for residents. A ‘policy of the week’ is given to all staff to sign Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 27 their understanding and the new policies covered so far include – abuse, medication, access to files, bullying, accidents and injuries, care planning. The manager is to introduce a ‘key worker’ system to ensure care staff are involved with the residents and take more delegated responsibility for their care and support. The manager is yet to organise supervision and she is aware that this should be done. An application is yet to be made to Commission for registration of the new manager. The time scale for this is 31/5/07 and the manager confirmed her application is almost completed. The manager is trained in NVQ Level 4. The new manager shows clear lines of responsibility and is to continue staff meetings to outline changes and work to be done. Residents and staff spoken with said they are confident that improvements will be made. Comments from residents: “Carol the manager is doing as much as she can”. Resident. “New manager is smashing. On the ball” Resident. The manager is yet to organise a quality assurance survey as the residents and relatives have been surveys at each of the random and key inspections conducted by CSCI. The manager is yet to organise a residents/relative meeting to introduce herself to the home. The resident’s handle their own finances were possible and records are kept of all transactions made for personal allowances. Finances for three residents were viewed and showed that a balance of accounts is made. All personal allowances are ‘pooled’ within the homes account and money is obtained for residents via a petty cash system. Discussion took place with the manager and owner to inform that this system was not to be used, residents monies must not be ‘pooled’ and a separate ‘personal allowances’ account must be used for each resident, receipts obtained and records for all transactions made. Were residents accumulate monies within their personal allowance account the resident/families must be encouraged to open a post office account/ or bank account. The manager has recently updated the policy on finance and it states ‘the home will not hold monies over and above £100 and an account must be opened’. The manager and owner confirmed that this system will be changed and individual personal accounts kept in a safe place and accessible to the residents. The manager has been spending time getting to know her staff and is working shifts both weekday and on a Saturday. A staff meeting took place on 2/3/07 and 26/4/07 and ongoing meetings will take place every three months to keep staff up to date of progress. The manager is making progress in organising staff training and confirmed that this will continue until all staff are up to date. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 28 The manager has developed a COSHH register and safe storage has been organised. Fire records are kept up to date and equipment serviced regularly. A fire risk assessment was completed on the building. All certificates for services were viewed and found to be in date. All accidents /injuries are recorded and records viewed. Risk assessments are being up dated for safe working practices. Discussion took place with the manager and owner re financial viability as the home occupancy levels had reduced to 14 residents. The owner said there are no concerns at present as the home is part of three homes that they own in the Southport area. Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 29 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 3 2 2 3 3 Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 30 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 OP27 Regulation 18 Requirement The manager must ensure sufficient staff are on duty to meet the needs of the residents. Time scale from last inspection not met 18/03/07. Timescale for action 31/05/07 2. OP29 19 3. OP33 12 The manager must conduct the 31/05/07 correct recruitment and selection procedures when appointing staff who have left the service and return. The manager must continue 31/08/07 update the policies and procedures, make these available to staff to ensure the safety of the residents. Residents’ finances must not be ‘pooled’ in the home’s account. The home must not pay monies belonging to a resident in any bank account unless it is in the name of the resident. A copy of the duty rota of persons working at the care home must be maintained. 30/06/07 4. OP35 20 5. OP37 17 31/05/07 Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP31 OP28 Good Practice Recommendations It is strongly recommended that the manager completes an application to CSCI to be appointed as the registered manager for the home. The manager should continue with its programme of NVQ training for staff to ensure they have 50 staff with a qualification in care. A core group of regular staff should be employed to avoid using staff who are not familiar with the residents needs. The manager should provide regular staff supervision. 3. 4. OP27 OP36 5. OP10 Key workers, when in place, should complete an audit of residents clothing and to continue labelling of residents clothing to avoid losses and ensure laundered clothing is returned to rightful resident. Paper towels should be provided in communal areas to avoid cross infection. The home should provide a temporary cook to cover during the permanent cooks absence to avoid care staff having to cover, which results in a reduction of staffing levels. The manager should monitor hours worked by those staff who work at other homes to ensure that excessive hours are not worked. The manager should arrange resident/relative meetings to keep them involved with the changes and developments. 6. OP26 7. OP27 8. OP27 9. OP33 Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 32 10. OP33 The manager should develop quality-monitoring systems to obtain feedback from residents, visitors and other professionals on the service provided. Abuse training should be provided to all care staff. The home should continue to improve and aim to promote the service to encourage prospective residents and raise occupancy levels. The provider should conduct regulation 26 visits and complete a report on the quality of the service and a record of this report made accessible for the inspector to view. The complaint records maintained should demonstrate the comments/grumbles made regarding the service and the outcomes. When staff administer when required medicines there should be written guidance to help ensure the medicines are administered correctly. 11. 12. 13. OP30 OP35 OP33 14. 15. OP16 OP9 Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Abbotsbury DS0000065441.V340600.R01.S.doc Version 5.2 Page 34 - 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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