Inspection on 21/02/06 for Abbotsfield Hall Nursing Home

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 16/08/05

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 Unannounced Inspection 21st February 2006 12:30 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 Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Abbotsfield Hall Nursing Home Address Abbotsfield Tavistock Devon PL19 8EZ 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) 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 DS0000003572.V269989.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users aged 65 years and over PD(E) Maximum registered 28 service users (both) OP Maximum registered 28 service users (both) Date of last inspection 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 residents. There is a large accessible garden. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 hours 30 minutes and was unannounced. This was the homes second statutory inspection of the year 2005-2006 readers may wish to consider the content of both reports to gain a full picture of the homes achievements. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Individual records of care held on behalf of 2 residents were inspected. The inspector spent the majority of the time talking with 10 residents and 1 visitor and 1 registered manager/provider and took time observing actual practise. What the service does well: This home has an organised, cheerful and friendly feel to it. The residents spoken to confirmed that the staff are kind, helpful and hardworking. The inspector observed that the interaction between the staff and service users was extremely good, each individual being treated with respect in a supportive manner. Feedback about the food served in the home was also good, people said it was of good quality and served in ample portions, options to the main dishes are always available and individual dietary needs are catered for. Drinks were seen to be available and regularly offered. The environment is clean and cheerful; the décor and furnishings in bedrooms are based on the individual choice of those living with in them. The management of the home is professional and approachable. Quotes received from residents during this inspection included: ‘ the staff couldn’t be better’ ‘the staff are very kind and nice’ ‘I have no complaints couldn’t have better even if we were in a hotel’. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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 Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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): 1,3,5 The information provided to prospective residents and or their representatives is reflective of the actual services and facilities available in the home. Sufficient information is obtained about prospective residents to ensure the admissions process is safe. People are invited to visit the home before making a decision about admission. EVIDENCE: The inspector randomly examined personal documentation held on behalf of 2 residents; both included pre-admission information supplied from care management or hospital settings about the residents assessed needs. The inspector spoke to a number of residents about how they had made the decision to be admitted to the home, the inspector was told by one person that they had known the home for years as their father had helped with the garden in the 1890’s when the building was a private residence and they had visited it often in their earlier life the resident confirmed they had made the right decision because they felt very ‘at home’. Another resident said they had heard about the homes good reputation from people who had visited the home. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 9 Another resident said they and their relative had been given the opportunity to visit At the time of the inspection the relative of a prospective resident came to look around the home. the home and assess its suitability before making a decision to stay. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10,11 One of the care plans seen had not been fully completed, this poses a risk to residents, as staff may not recognise a persons needs or be consistent in their approach to meeting them. The health care needs of residents are regularly reviewed and action is taken to meet those needs. The medication system is well managed and safe. Residents are well cared for at the time of and approaching their death and relatives and friends are well supported. EVIDENCE: The 2 documented assessments seen, provided information about skin integrity, moving and handling and nutritional needs and information about past occupations and contacts. The documents had not been dated or signed by the persons responsible for completing them. This information obtained following admission and the information supplied before the individuals admission generates the plans of care, which provide the basis for the care to be delivered. The inspector viewed 2 residents’ care plans; one had not been fully completed despite the resident being in the home for over a month. Daily records are maintained describing the care provided and any change in condition. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 11 Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, chiropodists and physiotherapists, dentists also visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Residents told the inspector that the staff respect their privacy and dignity, the inspector observed that when personal care was being provided this was done behind closed doors, the staff spoke to residents in a polite manner and were witnessed to knock on the doors to private accommodation before entering, Screens were seen to be available in shared rooms. The medication system is managed by registered nurses; the inspector looked at storage and recording – controlled drug stock was checked against records and found to be correct. Disposal of unused medication is safe, well recorded and removed by a licensed contractor. A letter from a bereaved relative provided evidence that they had been very satisfied with the care provided to a resident for a number of years whilst in the home and particularly at the time approaching their death. The letter thanked the staff for their friendship and support saying it had been a privilege to have been involved with such ‘a caring and supportive environment’. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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 the following standard(s): 12,13,15 Social activities are organised and provide stimulation and interest for residents. Meals are nutritious and balanced offering a healthy and varied diet for residents. The arrangements for residents to receive visitors are good. EVIDENCE: Following admission to the home, the staff usually record details of each resident’s social history, which includes past occupations. At the time of the inspection residents were seen socialising in the lounge or watching television others were spending time in their rooms, reading or listening to music. Newspapers are ordered for those who would like them. Residents told the inspector that they regularly enjoyed musical entertainment. The feedback about food was positive all of the residents spoken to said how good it was; on the day of inspection lunch was served, residents were offered beef stew and dumplings with mixed vegetables and potatoes or sardine salad, the main meal was followed by treacle pudding and custard. The afternoon tea was served with homemade buns the evening meal advertised was sandwiches followed by milk jelly. Breakfast advertised was a choice of cereals, porridge, prunes and toast with either marmalade Jam honey or marmite and a cooked breakfast available on request. Records seen provided evidence that resident’s weights are regularly monitored. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 13 The people living in the home told the inspector they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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 the following standard(s): 16,18 People’s complaints will be listened to, taken seriously and acted upon. Policies and procedures are in place and have been communicated to staff to protect residents from allegations or suspicion of abuse. EVIDENCE: The complaints procedure is communicated to residents and/or their representatives, a notice explaining the procedure was found displayed in the entrance hall, the information is in enough detail to ensure people have the means to refer a complaint to the Commission at any time. Residents told the inspector if they had issues or concerns they would speak to the matron/managers who are ‘very approachable’, and ask regularly if residents have any problems. The inspector also noted that there is a book in the entrance hall titled ‘complaints/comments there were no entries in this inspection year. The homes policy and procedural manuals were also displayed in the entrance hall, staff sign and date records to indicate they have read and understood the policies. Policies and procedures were available for the protection of vulnerable adults and included national and local guidelines and a whistle blowing policy and procedure. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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 the following standard(s): 19,21,24,26 Abbotsfield Hall is a large detached historic building it is simply decorated and furnished in a homely fashion and is clean and pleasant. The lack of locks on resident’s bedroom doors impacts on their personal choice with regard to privacy, dignity and security. Fire doors being wedged open pose a risk to the safety of residents living in this home. Poor practises of leaving tubs of creams and soap bars in communal bathrooms poses a risk of cross contamination of bacteria and provides a risk to residents of cross infection. EVIDENCE: Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 16 The building is old and has an interesting history it has been converted for its current purpose; it provides a homely environment for people who like a large and light feel to their home. A passenger lift and stair lift provides access between the floors. 2 bedrooms are suitable only for mobile residents as they are accessed via steps. The home is well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. Residents do not currently have an option to shower instead of bathe. Specialist mattresses were seen in place for those residents requiring them as were height adjustable beds. Resident’s rooms contained personal items of furniture, ornaments and pictures, despite a requirement to provide locks to residents personal accommodation this has not been performed. A tub of skin cream was found in a communal bathroom the tub did not contain the identity of the resident it was to be used for 2 bathrooms were seen to have soap bars in them this is poor infection control practise. The inspector found the door to one bedroom held open With a wooden wedge and the resident confirmed they liked their door open, this poses a risk of spread should a fire occur and a requirement has been made that where residents want the doors to their bedroom open this must be done by a ‘safe’ hold open device following advice from the Devon Fire and Rescue department. Hand washing facilities are available through out the home and protective latex gloves were also seen to be available. The environment was clean and odour free. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 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 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 The deployment and number of staff on duty during the inspection met the needs of the residents. EVIDENCE: Most of 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’. One resident said sometimes they felt the staff were rushed but this was usually if a member of staff could not come in because of sickness. On the day of inspection there were 23 residents in the home one of the managers was available in the home providing Registered Nurse cover, with the assistance of 4 carers in the morning, 2 carers in the afternoon and evening and 1 Registered Nurse and 1 carer at night. In addition to the care staff there were ancillary staff on duty for catering and domestic/laundry duties. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,38 The home is being managed effectively and in the best interests of its residents. Failures to ensure that bedroom doors are held open with ‘safe’ devices pose a fire risk to residents. EVIDENCE: This home is owned and run by two married couples the wives are both registered nurses and share the responsibilities of the position of Registered Manager between them. Both have recently completed the units required to obtain the Registered Managers Award. The inspector witnessed a good level of communication between the manager on duty and the staff residents, visitors/relatives and visiting professionals. At the last inspection 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. The inspector discussed the need Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 19 for safe approved (by the fire safety department) hold open device to be used and issued a requirement for this to happen despite this the same door was wedged open during this inspection if no action is taken as required, enforcement action may need to be taken to ensure resident safety. Records written by staff on a daily basis also indicated that another resident had wanted their door propped open there was no ‘safe’ hold open device on their door either. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 X 2 X X 2 X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 21 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 OP24 Regulation 12(4a) Requirement Timescale for action 01/04/06 2. OP26 13(3) 4. OP38 13(4) 23(4) 5 OP7 15 To ensure residents have the right to maintain their privacy, dignity and security. Rooms that become vacant (such as room 10 at the time of this inspection)must have locks fitted that are suited to capabilities and accessible to staff in emergencies. Extended from 01/10/05 To minimise the risk of cross 01/03/06 contamination/infection - pots of cream must be used for the individual they are prescribed for only and these and soap bars must not be left in communal bathrooms. Extended from 01/09/05 The registered person must 01/04/06 consult with the fire authority to ensure safe hold open devices are fitted to doors where residents wish to have the doors to their accommodation open Extended from 01/10/05 The registered person must 01/03/06 prepare a written plan for every resident with the involvement of the resident and/or their DS0000003572.V269989.R01.S.doc Version 5.1 Abbotsfield Hall Nursing Home Page 22 representative about how their health and welfare needs will be met RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP21 Good Practice Recommendations Consideration should be given to providing a shower room suitable for use by both independent and physically dependent residents. Abbotsfield Hall Nursing Home DS0000003572.V269989.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office 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 DS0000003572.V269989.R01.S.doc Version 5.1 Page 24 - 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. 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