Inspection on 16/08/05 for Abbotsfield Hall Nursing Home

This inspection was carried out on 16th August 2005.

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

Abbotsfield Hall Nursing Home 18/04/08

Abbotsfield Hall Nursing Home 06/06/07

Abbotsfield Hall Nursing Home 08/06/06

Abbotsfield Hall Nursing Home 21/02/06

Abbotsfield Hall Nursing Home 18/01/05

Abbotsfield Hall Nursing Home 13/07/04

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

CARE HOMES FOR OLDER PEOPLE Abbotsfield Hall Nursing Home Abbotsfield Tavistock Devon PL19 8EZ Lead Inspector Fiona Cartlidge Announced 16 August 2005 th 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. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Abbotsfield Hall Nursing Home Address Abbotsfield, Tavistock, Devon, PL19 8EZ 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) 01822 613973 01822 617260 Mr Eamon Charles Gaffney Mrs Hazel Gaffney, Mrs Pamela Watson, Mr Graham Watson Mrs Pamela Watson Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability over 65 years of age of places (28) Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19/01/05 Brief Description of the Service: Abbotsfield Hall is situated on the outskirts of Tavistock. It is owned and managed by Mr and Mrs Gaffney and Mr & Mrs Watson. There is 24 hour trained nurse cover supported by a team of carers and ancillary staff. . The home provides nursing and personal care for up to 28 older people of either gender with 16 single and 6 double rooms. The home is arranged on 2 floors with a passenger lift and stair lift available. A few rooms on the first floor do not have level access. The ground floor has two lounges and a dining room. It is well adapted in order to meet the needs of the service users. There is a large accessible garden. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 and a half hours and was announced. Information was received from the registered provider before the inspection as was written feedback from 5 residents and 4 visitors/relatives. A tour of the home took place and personal records of 3 residents and 3 staff were inspected. The inspector spoke to 2 members of staff on duty and 12 of the residents as well as the registered owners/manager. What the service does well: What has improved since the last inspection? The standard of documentation of individual plans of care has improved and now reflects the good standard of care actually being provided in the home. Risk assessments have been performed documented and reviewed improving the overall safety and reducing risks to staff and residents. Six bedrooms have been fitted with new carpets. ‘safe’ vinyl flooring has been fitted to a bathroom/WC. One bedroom has been redecorated. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 6 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. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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 Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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) 3,5 The admission procedure is adequate and provides enough information to guide staff on the actions to be taken to ensure new resident’s needs are assessed and planned for. Residents have the opportunity to visit the home or have a short- term admission before choosing to live in the home. EVIDENCE: The inspector examined the personal records held within the home on behalf of 3 of the residents (10 ) these contained information about the individuals’ health and personal care needs; the information had been obtained prior to admission from social and health care professionals. Some residents are visited in their current settings to enable the registered nurses to make a professional judgement about how needs will be met before offering the individual the opportunity of admission, it was advised at the time of the inspection that the assessor use the homes admission assessment tool and record findings and date and sign it to ensure a consistent approach is taken. Residents told the inspector that the home had been recommended to them through word of mouth. One lady explained that she had visited and viewed Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 9 the home and then made a decision stay. One resident had been admitted as part of a winter pressure scheme to reduce admissions to hospital and had made a decision to remain in the home long term. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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) 7,8,10 The health care needs of residents are regularly reviewed and action is taken to meet those needs. The social needs of residents are not always sought and no plan of how they could be met, this poses a risk for social needs not being addressed. EVIDENCE: The home provides a health and personal care planning process for residents based on continual assessment of their needs. Three care plans viewed during the inspection were fully completed and appropriately reviewed. The plans did not include detail about social needs or preferences and the inspector discussed the need to assess each individual’s social needs to enable a social care plan to be formulated. The written feedback from 5 residents indicated that they all feel well cared for, are treated well by the staff and that their privacy is respected. Documentation provided evidence that General Practitioners, chiropodist, dentist and opticians visit residents and that they are referred to specialist community and hospital health specialists when necessary. A GP who visits the home regularly attended at the time of the inspection to see a resident, he spoke highly of the standard of care provided and the level of satisfaction communicated to him by the residents. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 11 Written feedback from 4 relatives/visitors indicates that they are kept informed of important matters affecting their relative/friend and all were satisfied with the overall care provided. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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) 12,13,14,15 Social activities are organised and meet the needs of residents. Meals are nutritious and balanced and offer a healthy and varied diet for residents. The visiting arrangements are flexible and meet the needs of residents and visitors alike. Residents are encouraged to make choices about how they live their lives within the community of this home. EVIDENCE: People spoken to said the activities arranged and offered in the home suited their needs and preferences. The written feedback received from 5 residents indicated that all of them were satisfied with the social activities provided in the home. There was no organised social activity on the day of the inspection, residents were seen sitting in the garden, reading and receiving visitors. All of the verbal and written feedback about the food served in this home was positive; alternatives to the main set meal are advertised and available. Resident’s weights are regularly recorded in a care book, but there was little evidence that changes in weight were monitored and action taken or referrals made to dieticians. The three personal records seen by the inspector did not include evidence of nutritional assessments or screening. The people living in the home told the inspector they were happy with the visiting arrangements, written feedback from 5 relatives/visitors indicate that Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 13 they feel welcomed into the home and are able to visit their relative/friend in private in their bedrooms or socially in the lounge. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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) 16,18 People are safe living in this home and most know who to speak to if they are dissatisfied. EVIDENCE: The inspector examined the homes complaints procedure, which is displayed on the notice board in the entrance hall as well as in the policy and procedures files. The inspector looked at a hard backed book, containing a record of complaints and can confirm that no complaints have been recorded in this inspection year. Written feedback was received by the commission from 4 visitors/relatives; three indicated that they were aware of the homes complaints procedure and 1 indicated that they had actually had to make a complaint. The written feedback received from 5 people living in the home indicated that 3 knew who to speak to if they were unhappy with their care and all indicated they feel safe living in the home. One visor/relative commented ‘I haven’t made a complaint, but a suggestion which was taken on board. The homes policies and procedures manual contained information about how to recognise and report allegations or incidence of abuse and a whistle blowing policy an alerters guide was found in the nursing staff office. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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) 19,20,21,22,23,24,25,26 The providers maintain an adequately presented environment for residents and staff that is well maintained and safe. Lack of disposable hand towels in the staff WC poses a risk of poor hand hygiene which may lead to cross infection/contamination. EVIDENCE: Maintenance records were examined and confirmed that fire and lifting equipment and emergency lighting systems are regularly serviced by people who are qualified to do so. The fabric and decoration in the home is comfortable and homely, a number of carpets and the flooring in bathrooms have been replaced since the last inspection. Resident’s bedrooms showed evidence that they are involved in choosing their décor and are able to bring furniture and personal items with them into the home. Only one bedroom was being shared at the time of this inspection and screening was in place to promote privacy and dignity. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 16 The home was found to be clean however there were unmarked/named pots of skin creams found in 2 of the bathrooms, it was agreed that these would be removed and thrown away immediately at the time of the inspection. There were no disposable hand towels in the staff WC. One resident stated that they would like a shower with vertical hand bars to promote their independence. Residents were observed enjoying the well-maintained, safe and accessible garden. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 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) 27,28,29,30 The procedures for the recruitment of staff are not consistent and do not always offer protection to people living in the home. The number and skills of staff available in the home meets the needs of those living in the home. EVIDENCE: Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 18 The residents told the inspector that there were enough staff on duty, they said they ‘worked hard’ and were ‘very caring’ –‘nothing is too much trouble’. The staff spoken to also advised the inspector that they felt there was sufficient numbers of staff on duty and said they had access to training and development. The inspector examined the personnel files of 3 recently employed members of staff these provided evidence that the recruitment process is not consistent and safe. One file contained all of the records and information required, one had a Criminal Record Bureaux check supplied form a previous employment and no proof of the person’s identity and another lacked a written reference and proof of identity. There were no copies of terms and conditions of employment, job descriptions were found in a policy folder. The inspector examined training records these indicate that most staff receive regular training/updates and that a very high percentage of the Care staff have already obtained a National Vocational Qualification. Written feedback from 4 relatives visitors was received 3 indicated that there is always sufficient numbers of staff on duty. Comments such as ‘all the staff are kind cheerful and always helpful’ were received. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 19 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) 33,35 and 38 The home is being managed properly, there is clear leadership, guidance and direction to staff to ensure residents receive consistent quality care. EVIDENCE: The inspector witnessed a good level of communication between the manager on duty and the staff residents, visitors/relatives and visiting professionals. A record of regularly held staff meetings was seen and residents told the inspector they felt happy to discuss any issues with the registered providers because they see them on a regular basis and feel that they do all they can to meet their needs. The inspector checked the actual balances of money held on behalf of two residents with the records and found them to be correct, receipts are retained and a record of all transactions is made. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 20 Training records showed a commitment to health and safety matters in the home with a number of staff attending a 12 week health and safety course. Risk assessments were documented and examined. One resident assessed as high risk of falls needs to have solutions to minimise the risk of injury further explored in a manner, which will not restrict liberty or choice. The inspector discussed the use of a pressure alarm floor pad to alert staff when the resident is mobile. Records confirmed that all electrical equipment has recently been tested a visit was made by an environmental Health officer in August 2004 and the recommendations recorded have been acted upon. All radiators have been fitted with covers. The inspector noted that 1 bedroom situated on the 1st floor had its door held open with a wooden wedge the resident told the inspector they liked to have the door open, especially on a hot day. The inspector discussed the need for safe approved (by the fire safety department) hold open devices to be used. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 21 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 x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 2 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 2 Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 22 yes 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 24 Regulation 12(4)(a) Timescale for action To ensure residents have the Carried right to maintain their privacy, forward dignity and security. Rooms that new date become vacant (such as room 10 01/10/05 at the time of this inspection)must have locks fitted that are suited to capabilities and accessible to staff in emergencies. To minimise the risk of cross 01/09/05 contamination/infection - pots of cream must be used for the individual they are prescribed for only and must not be left in communal bathrooms. The Registered Person Must not carried employ a person to work at the forward to be care home unless he has obtained in respect of that completed person all of the information and by documents specified in 01/09/05 paragraphs 1-7 of schedule 2. The registered person must 01/10/05 consult with the fire authority to ensure safe hold open devices are fitted to doors where residents wish to have the doors to their accomodation open Requirement 2. 26 13(3) 3. 29 19 4. 38 13(4) & 23(4) Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 21 26 Good Practice Recommendations Each residents social care needs should be set out in their individual plan of care. Consideration should be given to providing a shower room suitable for use by both independent and physically dependent residents. To encourage best practise and good hand hygiene - a disposable towel dispenser should be fitted in the staff WC. Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Abbotsfield Hall Nursing Home D54-D07 S3572 Abbotsfield Hall V233533 160805 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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