CARE HOMES FOR OLDER PEOPLE
Abbotsbury Mead End Biggleswade Bedfordshire SG18 8JU Lead Inspector
Dragan Cvejic Unannounced Inspection 24th October 2005 08:00 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 DS0000014873.V261131.R01.S.doc Version 5.0 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 DS0000014873.V261131.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Abbotsbury Address Mead End Biggleswade Bedfordshire SG18 8JU 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) 01767 313366 01767 312822 BUPA Care Homes (Bedfordshire) Ltd Mr Colin Bunyan Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (32) Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th June 2005 Brief Description of the Service: Abbotsbury is a purpose built home for older people; it is a part of BUPAs 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 the main line railway allow easy access for those travelling to the home from a distance. A car parking facility is 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. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a short, unannounced inspection where the outcomes of the service were checked with service users, they commented on admission, on daily life, activities and the atmosphere in the home. Staff satisfaction, morale, training and commitment were also checked in order to measure stability of the good care provided in the home. Seven service users and three staff members spoke to the inspector. The quality assurance survey results provided clear answers regarding the quality of care, respect and choice offered in the home. The home continued to provide well organised and stable care in a comfortable environment. This inspection confirmed the standards achieved on a previous occasion and this report should be read together with the report from the previous inspection when most standards were checked. What the service does well: What has improved since the last inspection?
Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 6 The garden project included not only the main, enclosed central garden, but also small enclosed gardens accessible from each unit in the home. Now, these areas were also used. The local community, staff and family members were involved in this innovative garden project that formed another connection with the community for service users. Since the nearby day centre changed the operational principles, some regular attendants had stopped going there, the home had acted before the day centre was closed and had planned extra activities: outings, bingo was increased to 3 times a week, as service users wanted; A quiz was used for fundraising for further development of the activity programme, service users wanted to take an active part in it and refused the suggestion not to pay for taking part, as the other competitors, staff, relatives and friends from local community were all paying for it. Since the change regarding the day centre attendance, the home introduced a “shopping trolley” to ensure that service users still have access to this facility. Training records were now held in electronic form on a computer and this allowed the manager regular monitoring and easy planning, this process helped to keep the training and refresher courses up to date. 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 DS0000014873.V261131.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 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 the following standard(s): 3,4,5 The home ensured that by proper assessment, potential service users were reassured that their needs would be met, the home would refuse users admission if the assessment showed that their needs could not be met. The home offered a trial period so that both the home and the users could decide if their needs were met. EVIDENCE: A service user explained that he was assessed prior to admission, he stated that he had been at the home for about 3 months and added: “I have started to get used to it.” His trial was, obviously, successful. The manager talked about the initial assessment that resulted with a potential user being refused, due to a level of confusion, to her inability to control her mobility and the home’s capacity to meet her needs. All service users spoken to confirmed that they were happy and that their needs were met. A survey results demonstrated the same. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 9 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): 7,8,10 Service users knew about their care plans and were happy with the way of the process that involved them. EVIDENCE: Service users spoken to stated that they knew the content of their care plans. A service user commented that he specifically asked staff to help him in a particular way and that was recorded in his care plan, he also stated that staff asked him every month if he wanted or needed anything different. Written care plans were not inspected as service users confirmed that the outcome of care process met the expectations and standards. Two staff members were observed helping a service user with mobility problems to transfer from a wheelchair to a chair. The manager dealt with a service user with dementia and used a respectful and appropriate technique that was effective for this particular user. Cleaners were observed during their work in users’ individual bedrooms, they knocked on the door before entering and had a friendly and supportive attitude to service users. Service users were respected and their individuality was promoted through working practices. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 10 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, 15 Service users were involved in creating a daily routine of the home that suited their needs, expectations and preferences. EVIDENCE: The change of the operational principles of the day centre next door, had an impact on service users and that was the main topic that preoccupied users’ conversations and they focused on the consequences of this change. The home responded appropriately by reviewing their own activity programme, Bingo was increased to 3 days a week, as service users requested, and a new type of quiz was introduced. A service user declared in the quality survey, her satisfaction with the arrangement for her to get up earlier, as she wanted. Service users had regular meetings and discussed all aspects of running the home, creating a routine and they demonstrated that choice and autonomy were promoted and respected. Contact with the local community was affected with the change of the day centre working practice, but the manager and service users were exploring alternative ways to maintain and improve these contacts. A garden project and quiz had already partly replaced the loss of the use of the day centre facilities.
Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 11 Several service users had small amount of their personal allowances with them and were proud of being able to manage some of their finances. BUPA offered help to those that needed a higher level of support to manage their own money. All the comments regarding food, made verbally to the inspector, in the quality survey and even comments overheard by staff were positive and gave praise to the choice, quality and quantity. The cook was determined to maintain this high standard and to meet all the needs and wishes of the service users. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 12 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): 16,18 There were no complaints since the last inspection and the procedure was in place and available to all people involved in the home’s life. Service users were protected by the safe working practices, by the robust procedures in place to protect them and by the empowerment to express their voice. EVIDENCE: The home displayed a “complaints procedure” that clearly described the process of making a complaint and also showed the appropriate sources where potential complaints could be directed. There was a whistle blowing policy displayed in the staff room. The staff were aware of the protection issues, procedures and policies. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 13 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): 19,20,22 The home was comfortable, homely, bright and clean and service users enjoyed easy access to all areas of the home. A bungalow style building, all on one level, enabled service users to exercise their autonomy to the full extent. EVIDENCE: The premises were maintained according to the home plan; the manager was in the process of making a new plan for the New Year 2006. The small gardens were revamped and became usable thanks to the staff and their families, the central garden were also well maintained and used in good weather by many of the service users. All shared facilities, lounges and dining areas were clean and comfortable, the majority of the service users spent their time in the home socialising in these areas. The individual bedrooms checked were comfortable and appropriately arranged and equipped for each individual, a call bell system was effective and used by many service users, two examples were seen during the inspection.
Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 14 Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 15 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 The home engaged an appropriate number of staff, with sufficient skills and experience to meet the needs of service users. EVIDENCE: Some key staff had left the home since the last inspection, mainly to progress elsewhere; most were replaced by the effective recruitment from the home’s bank staff list. This ensured continuity of the care and stability for service users. The NVQ training was still popular among staff, but with the number of NVQ trained staff and with no organisational incentive for those qualified, in terms of a different pay level or objective chances for progress within the home, there was a risk of qualified staff leaving the home. The staff spoken to expressed this realisation to the inspector. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 16 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): 31,32,33,38 The home was managed in an open, creative and inclusive way and service users benefited from appropriate leadership. The experienced and skilled manager ensured that service users were protected and that safe working practices were in place. EVIDENCE: The same manager remained at the home as when previously inspected and ensured that the home operated to the same standards. The manager stopped overseeing the day centre and could focus even more on the home. Staff talked openly, to the manager, to each other, to the inspector and to other service users. Their commitment was noticed from the comments such as the cook’s:” I will overspend on the budget, if that is the way to provide little extras to service users, they deserve this”. The staff engagement in the garden project; this was whereby the staff members organised people from the local community to help, this also demonstrated staff commitment. The quality survey carried out, gave much better results that the previous one, since the home had started using an adapted questionnaire, that service users
Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 17 clearly understood. The manager explained that business plan for the following year would be created from the results of the quality assurance survey, among other comments from users, staff and visitors. The home exceeded the standard requirement regarding quality assurance, and users benefited from these extra measures implemented in the home. The new principle for keeping track of staff training, now in electronic form, helped the manager to closely monitor training; as a result, the monthly audit indicated who was due for refresher courses. This method improved the effectiveness of planning the training for all mandatory and extra courses offered to the staff. Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 18 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X X X X 3 Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 19 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. 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 OP18 Good Practice Recommendations The home should keep up to date and signed records of service users possessions in each service users file. This recommendation remained from the previous inspection and the manager was exploring different methods to meet the recommendation. However, the final effectiveness was not achieved and the task remained for the manager to identify the method that would provide expected outcome. The manager, the home and the organisation as a whole should consider introducing some effective incentive for NVQ qualified staff and improve retention. 2 OP28 Abbotsbury DS0000014873.V261131.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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 DS0000014873.V261131.R01.S.doc Version 5.0 Page 21 - 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!
