Inspection on 13/02/07 for Abbotsford

This inspection was carried out on 13th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Abbotsford 20/11/07

Abbotsford 13/02/06

Abbotsford 12/10/05

Abbotsford 27/01/05

Abbotsford 01/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Abbotsford 53 Moss Lane Pinner Middlesex HA5 3AZ Lead Inspector Clive Heidrich Key Unannounced Inspection 13th February 2007 9:30 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 Abbotsford DS0000017515.V325618.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. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsford Address 53 Moss Lane Pinner Middlesex HA5 3AZ 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) 0208 866 6030 020 8426 2257 Mrs J Spanswick-Smith Mr Derek Spanswick-Smith Mrs J Spanswick-Smith Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: Abbotsford is a care home providing personal care and accommodation for up to 24 older people. One room was registered as a double room, but is now used only by one person. The group of people living at the home at the time of the inspection were of mixed gender. There were 22 people living at the home at the time of inspection. The home is a family-run business, having been established by the owners in the 1960’s. Mrs Spanswick-Smith, one of the owners, manages the home. The family own a similar care home, Glengariff at 59 Moss Lane. Service users with lower dependency care needs are accommodated in Abbotsford. The home is situated in a quiet residential area of Pinner, fifteen minutes’ walk from local shops and public transport links. The forecourt has parking for a maximum of eight cars. The building has a ground and a first floor. Access is by passenger lift or stairs. All bedrooms are fully furnished, with some on the ground floor. The home has three communal bathrooms, one of which has facilities to support with getting in and out of the bath. There are other individual toilets available. The home has a large lounge that is split into a number of openlyinterconnected areas, one of which doubles as the dining area. The home also has a good-sized and well-maintained garden. References to the manager in this report refer to Mrs Karen Spanswick-Smith, the daughter of the registered manager, who oversees most aspects of day-today management at this home. She is also registered as the manager of the sister home at Glengariff. The fee range for this home was £450 to £500 at the time of the inspection. The manager noted that this was due a review by April. The Service User Guide is available in the home’s entrance hall, and on request. Abbotsford DS0000017515.V325618.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 across one weekday in the middle of February. It lasted seven and a half hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke with a number of residents and relatives during the visit, all of whom were able to provide feedback about the services in the home. A CSCI residents’ survey was sent to a number of homes in early January. At the time of writing, 16 of the 23 surveys for this home had been returned to the CSCI, which is an encouragingly high percentage. Feedback was very positive overall. Details of the surveys are noted throughout this report. The inspection process within the home also involved observations of how staff provided support to service users, discussions with staff, checks of the environment, and the viewing of a number of records. Feedback was provided to the manager at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: The home has been family-run successfully for over forty years. It continues to hold a good local reputation, with many people moving-in based on word-ofmouth. Feedback from residents about the home includes ‘I am very satisfied with the home’ and ‘I am more than happy with the home.’ Particular comments about services at the home are included throughout the report. The home provides a safe, clean, and homely environment for residents who are relatively independent and capable. The home has an established staff group with low staff turnover. Staff have good knowledge of residents’ individual needs and wishes, and treat residents pleasantly and respectfully. There are strong standards of healthcare, including through liaison with community health professionals. There are strong standards of food and nutrition, with good knowledge of individual preferences. There are also good standards of supporting contact with family and friends, and with providing community support. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 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 Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents receive suitable information about the services at the home before deciding if they would like to move in. Management at the home also make a decision about whether they can meet the prospective resident’s needs before offering admission. The only improvement needed is with making details about costs and services clear on the service user guide. EVIDENCE: The home had a service user guide and a statement of purpose. The service user guide has not yet been updated with regards to the Amendment to the Care Homes Regulations 2001, which requires that details of the prices of the placement be detailed within the guide. Amendments would better enable prospective residents and their representatives to make an informed choice Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 9 about the home including with respect to costs and services. Management must address this. The manager stated that all residents in the home are privately-funded and that they all have copies of a contract which is agreed at the point of admission. The vast majority of survey responses confirmed that they have received contracts. All survey responses also confirmed that they received enough information about the home before moving in, to help decide if the home was right for them. One person noted that they were given information about the services, and then provided with a tour of the home. Some others explained that they received positive information about the home from independent sources, to help with their decisions about moving in. There were written assessment records in place for new service users, generally pre-dating the admission date. They considered the needs of the service user, so enabling a professional decision about offering placement to be made. Consideration should be given to enquiring further about life histories within this assessment process, if the prospective resident and their representatives are so willing, to better inform the home about needs and abilities of the prospective resident. The manager and the majority of staff have worked in the home for a number of years and were familiar with the needs of older people. They know the residents well and all residents appeared well cared for. The surveys received by the Commission, and feedback from residents and visitors, provided a great deal of positive feedback about the services at the home. This includes that 12 surveys noted that the resident always receives the care and support that they need, with the four others stating that this usually happens. A typical comment was that the resident is ‘very happy living at Abbotsford’ and is ‘very pleased with the care and support provided there.’ In conjunction with checks of individual resident records, it can be concluded that the home is able to meet the needs of people who move into the home. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides good standards of respectful and individualised care to residents. Plans of care support this to some extent. However, improvements are needed to ensure that the plans document about changing care needs and that residents and their representatives are clearly offered involvement in the planning. Residents’ care needs are generally appropriately met, including through liaison with external healthcare professionals. Improvements are needed with ensuring that assessments of risk in key clinical areas are undertaken for each resident, to proactively prevent deteriorations. Medicines management in the home was not as thorough as it should have been to ensure the safety of service users. EVIDENCE: Observations of residents raised no concerns about the support that staff provide with personal care. The majority of residents were seen, and some Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 11 spoken with, during a full tour of the home. There was additionally no lingering offensive odours present in any areas of the home. Staff were seen to liaise with residents politely and friendlily. One staff member was seen for instance to say ‘excuse me’ to a couple of residents in conversation. Staff attempted to address residents’ requests, such as for working out where the newspaper requested by one resident was. Staff were seen to knock on doors before requesting entry into private areas. All surveys received noted that staff listen to and act on what the resident says. The majority stated that staff are always available when needed. Comments included that the staff are very caring, and that it is a happy home. The standard on respect and privacy is therefore judged as met. The care files of four service users were checked through. Care plans for each person dated from January 2007, however no review had taken place previously since July 2006. The plans themselves were reasonably detailed and relevant to the individual, noting for instance about personal support needs, communication difficulties, and nutritional wishes. They generally corresponded with assessment information. They lacked however a sense of being up-to-date, particularly around new or evolving health issues such as around skin care and eye conditions. Health records showed professional input in many of these respects, but clarity within care plans would help to ensure that the service user, their representatives, and staff are clear on the support to be provided over these developing needs. Monthly reviews of plans would help to ensure that these changes are recorded about. Management must address this. None of the care plans contained evidence of involvement or agreement by the resident or their representatives. This involvement could help to ensure that the plans address the needs and wishes of the resident. The manager noted that the resident and their representatives usually decline this opportunity. Evidence of their involvement, either actual or offered, is nonetheless required. Each file had basic general, night care needs, manual handling, and falls risk assessments in place. They provided simple guidance in the support needs of the resident. In one case, the falls risk assessment had not been updated following the resident having a fall. This is required, to ensure help prevent a repeat scenario. A nutritional assessment, including with respect to diet and weight, is required for each resident from point of admission and then with regular review, to ensure that concerns in these areas can be proactively addressed. There were records of monthly weight checks of residents, checks of which during the inspection raised no significant concerns. Similarly, assessments of potential to develop pressure sores, and hence proactively counter this, were not in place as required. There were however no reported pressure sores. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 12 The manager noted that a few staff have been on specific care-planning training, including for such areas as nutrition. They will consequently provide key support within implementing such assessments. There were detailed ongoing records of health professional input available for each service user. These included about dentistry, chiropody, the opticians, the GP, and in one case, an occupational therapist. A local dentist visited two residents privately during the inspection. The local district nursing service was also present during the morning, and appeared to be well-known to those working in the home. Checks of files found that the summary grids used to highlight health appointments within individual’s file were not up-to-date. This could result in health advice being incorrectly communicated, and so is recommended for updating. The majority of survey feedback found that residents receive the medical support that they need. Comments included that the home arranges for staff support with hospital appointments, and that GPs are called when necessary. The home’s medication cabinets were seen to be kept securely and tidily, with no evidence of stock-piling. A pharmacist supplies pre-packed weekly monitored-dosage packs for each applicable service user. Checks of these packs against records found medicines being administered correctly. There were a few gaps, and one case of signing against the wrong time, in the medication records. Checks of these gaps found that the medicine had been removed from the dosage pack, hence the medication was most likely given but not recorded about in these instances. However, records must be kept accurately to help ensure prescriptions are followed accurately and to help prevent such things as double-doses. Management must ensure that this is fully addressed. There were two cases found of medicines being given at a frequency less than that of the prescribed instructions. Management must ensure that the prescribed instructions are followed, and provide feedback to the GP if instructions appear not to benefit the resident so that prescribed instructions can be changed. There were records of the medications received by the home from the pharmacist, as required. There were no such records however for a respite resident, which could cause difficulties if questions arose over what was received by the home. Management must ensure that all medications received by the home are recorded about in suitable detail. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 13 Some service users self-medicate, and have secure facilities for this. However, the tour of the home found that these were not always being used. This can allow for medication to be lost or inappropriately used. Management must endeavour to ensure that residents who self-medicate keep their medicines securely. There were no dates of opening on bottles and creams. These are needed to ensure suitably timely disposal, based on infection control and product deterioration principles. The majority of bottles did however have very recent prescription dates on their labels. Some residents were seen to have a homely remedy procedure approved of by their GP. Records of administration were consequently in their daily logs. It is recommended that these records instead be within the medication files, so that they can be easily accessed and overviewed. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 14 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a good standard of home-cooked food that takes into account their preferences. The services at the home enables residents to exercise control over their lifestyles where possible. However, improvements are needed to provide a suitable programme of daily activities that responds to individual and collective preferences of residents. There are good standards of supporting contact with family and friends, and with providing community support. EVIDENCE: Surveys responses to the question, ‘Are there activities arranged by the home that you can take part in?’, had four responses of ‘always’, five of ‘usually’, and six of ‘sometimes’. This suggests some degree of dissatisfaction with activity provision. One person noted that their poor hearing prevented them from fully enjoying activities, however activities should include emphasis on the service addressing such individual needs. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 15 There was a sign in the lounge during the inspection that appeared to cancel a planned quiz. The manager asked staff to clarify to residents that the quiz was going ahead following its cancellation last week. Around ten residents joined in with the quiz later in the afternoon. The manager stated that a masseur had done a demonstration the previous week, and that they would shortly be hired for interested residents for an appropriate extra charge. There had also recently been a musician and a clothes show for residents. The manager also noted that they would shortly be hiring an activities co-ordinator to be shared between both homes. This is encouraging. The care plans of residents did not usually contain an assessment of their social and recreational needs and histories. As a result there was no guarantee that the activities in the home are tailored to the individual and collective wishes of residents. In conjunction with inconsistent feedback about activities, management must ensure that a programme of daily activities is arranged that addresses residents’ collective and individual preferences. Residents are free to assist with household tasks, albeit that none were seen to do this during the inspection. Residents can potentially help with cooking, however they are not ordinarily invited into the kitchen area for safety reasons. Residents were seen to have the freedom of the home, including the well-kept gardens. There were few residents in the lounge areas during the morning, however a tour of the home found that many had chosen to stay in their rooms. A few were going out. Records confirmed that residents are provided with support, where needed, for making trips out locally and for appointments. Staff understood about enabling residents to make choices about their lives. Staff spoke about aiming to allow residents to have choice about such things as when to get up if they need support. One staff member was seen to ask the small group of residents in the lounge mid-morning about whether they wanted anything, including the television being operated, all of which was declined. A number of residents were seen to have phones installed in their rooms (at extra cost of line rental). There is also a portable phone available for residents to have calls privately in their rooms, in addition to the fixed payphone in the hall. One visitor spoke of the flexibility afforded to visiting hours and arrangements. The manager noted that visitors may have lunch in the home, generally for a small charge. Another relative noted that the people at the home are ‘always very welcoming’ and that a ‘pantomime and a half’ was provided at Christmas. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 16 Five survey responses stated that the resident always likes the meals at the home. Eight stated this as ‘usually’ with one as ‘sometimes’. Comments included ‘good homemade meals’, ‘they are varied and nice’, and ‘alternatives are always available if a dish is not suitable.’ Feedback from residents during the inspection was also positive, with one relative also noting that ‘the food is excellent.’ Pork chops with potatoes and vegetables, followed by a dessert, was served for lunch during the inspection. The pork chops were tasted by the inspector, and found to be tasty and easy to chew. Food records showed a reasonable range of meals being home-prepared, including for instance roast dinners, fish pie, and lamb’s liver with onions. Home-made desserts such as apple pastry are also served. Evening meals are based around home-made soups, such as lentil or celeriac, along with sandwich and toast options. There was a good supply of food available in the home, including in respect of dairy products, fruit juices, and fresh fruit & vegetables such as tomatoes-onthe-vine. The manager noted that they avoid value-foods and aim for products that residents would be familiar with from before moving into the home. The kitchen contained much information about the food and drink preferences of residents, including those of someone who had moved in just two days ago, which is encouragingly prompt. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their complaints will be listened to and acted on. Improvement is needed with ensuring that the complaint book is available to record complaints in. The home has a number of processes to help ensure that residents are protected from abuse. Improvements are needed with linking the abuseprevention policy with the local council’s procedure, and with ensuring that bruises on residents are suitably recorded about. EVIDENCE: Surveys showed that the majority of residents always know how to make a complaint. Typical comments were that ‘I have had none.’ Copies of the complaints procedure were available in the bedrooms of service users and in the service users’ guide. There have been no complaints to the CSCI about this home since the last inspection. The manager similarly reported that there have been no complaints. The complaint book could not however be located during the visit. Management must ensure that is available, to ensure that any complaints made are fully recorded about. From the tour of the home, one resident was noted to have a visible dark mark on their forearm. Checks found that this arose from an accident, Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 18 however there was no record of it, and management were not aware of it. Such scenarios could potentially allow abusive behaviour to be unaddressed. Management must ensure that visible bruising and marks to residents are recorded about, and are investigated as necessary. The abuse-prevention policy for the two homes was recently checked during inspection of the other home. Improvements were needed to ensure that it worked in line with the Harrow Borough’s safeguarding adults policy, particularly around decisions of who would investigate allegations of abuse. The manager consequently reported as part of this inspection that their abuseprevention policy is being updated to meet that requirement. Staff noted that they had update training in abuse awareness in 2006. Records and the manager confirmed that this was for a number of newer staff, where established staff had the training in 2004. Staff were aware of basic procedures around the reporting of suspected abuse. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 19 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): All of them. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a pleasant and homely environment that is reasonably wellmaintained and which is kept suitably clean and hygienic. Improvements are mainly needed to some areas of communal carpeting to replace worn areas, and with ensuring that exposed radiators are provided with covers to reduce risks of scalding accidents. Residents are provided with single rooms which are kept comfortable and which can be individualised. There are reasonable amounts of communal washing areas and WCs, in addition to some en-suite bedrooms. There are some adaptations to assist with independence, including a passenger lift. EVIDENCE: Surveys responses included eleven responses of the home always being fresh and clean, with four statements of usually and one blank reply. Residents Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 20 raised no concerns about the environment during the inspection, and there were no observations of poor cleanliness. A tour of the home included a brief check of each bedroom, with the permission of the resident if they were present. This helped to confirm that there was no-one receiving poor care, that there were no lingering offensive odours, and that bedroom facilities were suitable. In particular, the service was ensuring that rooms are kept clean and tidy, and that residents can and do personalise their rooms. Some bedrooms have en-suite facilities. Radiators can be controlled within rooms, and hence most rooms were warm but a few were cooler to reflect the wishes of the occupant. Comments received during this tour included ‘the room is fine’, and ‘I’m very pleased to be here.’ Each room has a call-bell with which to request staff presence. The manager noted that the system allows for the bell to be extended to chairs within bedrooms if needed. The bells were heard to be used and responded to during the inspection. The home was additionally coping with water-mains work in the road at the time of the inspection. Feedback found that this was causing brief periods of the water being unavailable, and hence causing washing and meal routines to be sometimes running later. However, the evidence suggested that care to residents was not unduly affected. The inspection also coincided with a professional service of the lift, and with the redecoration of the main stairwell. The kitchen has been partly refurbished since the last inspection. Furnishings are now stainless steel, allowing hygiene standards to be more easily met. Kitchen equipment was being kept suitably clean. The laundry area was seen to have a new and suitable washing machine and tumble-drier, and many facilities to uphold infection control procedures. Most of the previous environmental requirements were found to have been addressed. This included the changing of stained carpets in bedrooms, and the replacing of a glass panel near the front door. One issue remained outstanding, that of fitting radiator covers where radiators are exposed, to help prevent scalding accidents. Documentation was provided to show that covers have been ordered. Documentation showed that a significant amount of carpeting would be replaced around the home, particularly in the lounge where the carpet was showing signs of wear near the kitchen. This contrasted with the pleasantly comfortable and traditional furnishings in the lounge area. Some areas of hallway carpet are also significantly worn. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 21 It was noted that the paving at the side of the house has been levelled, to assist with any residents who wish to use that area. Some bedrooms have doors directly into this area. The WC along the main corridor downstairs was in need of some refurbishment due to flaking paint around the washbasin, and the flooring being worn. The manager noted that further refurbishment work would be taking place for downstairs washing facilities. It was noted that one bathroom upstairs had been pleasantly retiled, and had facilities for assisting with getting into the bath including a riser-seat. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 22 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are capable of being met by an established and experienced staff team who are generally provided in sufficient numbers. There is a good mix of training amongst staff, including with respect to NVQ qualifications. However, improvements are needed with ensuring that staff are provided with complete refresher training in key areas, as this was not fully the case for some staff. The recruitment practices at the home sufficiently protect residents. EVIDENCE: There were five staff working from the start of the inspection. This included two carers, two people with cleaning responsibilities, and one cook. This enabled residents’ presenting needs to be addressed. The staffing levels for the previous week were checked through. These showed that there were three staff working from 8am, then between four and six staff working between 9am and 1:30pm. Three staff continued through generally until 10pm. One staff worked a waking night, with others who live on the wider premises available on-call. This all tallies with previously-agreed staffing levels except for the two occasions of there being only four staff working in the mornings when five should be present. The manager noted that this was due Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 23 to unexpected shortfalls that couldn’t be covered. Survey findings raised no major concerns about the availability of staff. The recruitment files of two newer staff were checked through. Both included the use of application forms that included employment histories, copies of identification checks, and two suitable written references. One person had a suitable Criminal Record Bureau (CRB) check in place, but the other’s was missing. Copies of the relevant documents were supplied after the inspection, including details of the person’s employment start date to show that they started after suitable checks were in place. For ease of checking, it is recommended that the start date be included in the recruitment file of each staff member. Management had also previously liaised with the CSCI over technical difficulties with acquiring the required legislative checks, which suggests a responsible attitude towards upholding service users’ safety through these checks. The manager stated that, in respect of the staffing hours, they have achieved the minimum expectation of 50 NVQ-qualified (or equivalent) staff. This includes three qualified nurses, and a couple of staff at the stronger level-3 NVQ qualification in care. This tallies with previous records sent to the CSCI by the manager, in conjunction with an ongoing low turnover of staff at the home. A number of staff have worked for many years at the home. Feedback from staff raised no concerns about training provision, noting that recent training in some key areas has been provided where needed. The manager confirmed that since the last inspection, a number of staff had attended training particularly in food hygiene, infection control, and abuseprevention. Planning was in place to update a number of staff in emergency first aid, and in manual handling, as per individual training records seen. The sample records seen lacked also food hygiene training, despite the recent updates, and typically fell a day short on the recommended minimum of three days’ paid training per year. This could all lead to shortfalls in staff knowledge, which in turn may cause inappropriate care to residents. The manager must address training shortfalls. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is established and capable management of this long-standing family business. The service at the home is suitably resident-focussed. The service suitably looks after the minimal amount of residents’ finances placed in its trust. Health and safety processes in the home generally protect people there. However some improvements are needed with keeping professional inspections up-to-date, and with ensuring that water temperatures from some taps do not present undue scalding risks. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has managed the home in recent years, alongside being the registered manager of the sister home down the road. Her mother remains registered as the manager of Abbotsford, as she previously took the role on fully, and remains much involved in the running of the home. There was positive feedback about the management at the home, including the comment from a resident that ‘the management and staff have been so wonderful and helpful to me.’ There was also positive feedback about the manager from staff, noting that she is supportive and available when needed. The manager has an advanced certificate in care management. Skills for Care, the sector training organisation, recommends that any qualification is compared with the Registered Managers Award and NVQ level 4 for care and that any shortfalls, if any, could be made up by taking the relevant NVQ units. This can normally be done by a local college. There were certificates on display to show that the business is a current member of the National Care Homes Association. The manager stated that they have recently sent residents and their representatives questionnaires about the quality of care in the home. The manager was working on analysing these at the time of the inspection, with a report to be made available at the end of this process. Management also ensured that the CSCI surveys were distributed promptly to relevant people. The service at the home looks after small amounts of money on behalf of a few residents. There were clear records of this money, including any transactions such as newspapers and private chiropody, and their corresponding receipts. It was encouraging to see that the service absorbed additional costs when an individual’s money on site ran out, until such time as reimbursement could be made. There were some minor arithmetic errors within some of these records. Staff explained that double-checks are sometimes made of the records. It is recommended that there be clear entries of when such checks are made. Professional safety checks were in place and up-to-date for the electrical wiring of the building, the gas systems, the passenger lift, the bath riser-seat, fire extinguishers, and for the water systems against legionella. Management provided documentation to confirm that similar checks have been ordered for portable electrical appliances and the fire alarm system, which must be completed promptly as these were out-of-date at the time of the inspection. The local council’s environmental health department undertook an inspection of some aspects of the home in January 2007. A summary report of this Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 26 identified only one area for improvement, in respect of fitting a designated wash-hand basin within the kitchen. Management noted that there are plans to address this within the remaining refurbishment work in that area. The report noted consideration of such things as cleaning schedules and staff training. The home has a fire risk assessment in place, with latest review date of October 2006. Management were aware of the changed legislation in respect of fire safety, and noted that they have hired a fire professional for a visit in March. This is to ensure compliance with the changed legislation. Checks are also documented weekly of the fire system by staff in the home. Two fire drills had been undertaken within the previous six months. This involved everyone in the home. There were also records of monthly fire discussions amongst a number of staff, all of which shows are good practice in respect of fire safety management. Weekly checks are undertaken by staff of three tap temperatures around the home. A few records showed occasionally excessively high temperatures, when the safe temperature for residents is 43ºC. This includes for two consecutive checks of an upstairs bathroom washbasin. During the visit, the inspector found the hot tap in the hallway WC to be unpleasantly hot, despite there being a thermostat fitted to piping under the basin. This lack of keeping hot taps to safe temperatures could lead to a scalding accident, which management must consequently address. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 27 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 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 5 Requirement The Service User Guide must be updated to include details about the range of fees that is charged by the home. Individual care plans must be kept up-to-date, particularly around new or evolving health issues such as for skin care and eye conditions. Monthly reviews of plans will help to ensure that these changes are recorded about. There must be evidence that the care plans and risk assessments are agreed with, or have been offered for consultation with, each resident and/or their representatives. Residents must have initial and ongoing assessments of their nutritional status, and similarly risk assessments with regard to falls and developing pressure sores. Medication sheets must be kept up to date, current and accurate. Previous timescales of 12/10/05 & 31/3/06 not fully met. DS0000017515.V325618.R01.S.doc Timescale for action 30/04/07 2 OP7 15(1, 2) 30/04/07 3 OP7 15(1, 2) 31/05/07 4 OP8 14(1, 2) 30/04/07 5 OP9 13(2) 15/04/07 Abbotsford Version 5.2 Page 29 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 10 OP9 OP12 13(2) 16(2)(m, n) 11 OP16 17(3)(b) 12 OP18 17(2) s4 pt 12(c) 13 OP18 13(6) 14 15 OP19 OP19 23(2)(b) 23(2)(b) Management must ensure that the prescribed instructions on medications are followed by the service, and provide feedback to the GP if instructions appear not to benefit the resident, so that prescribed instructions can be changed. The amount of all medicines received into the home at any time but which are not contained in the Nomad cassettes must be recorded. Management must endeavour to ensure that residents who selfmedicate keep their medicines securely. Dates of openings on bottles and creams are needed to ensure suitably timely disposal. Management must ensure that a programme of daily activities is arranged that addresses residents’ collective and individual preferences. Management must ensure that the complaints book is always available, so that any complaints made can be fully recorded about. Management must ensure that visible bruising and marks to residents are recorded about, and are investigated as necessary. The home’s policy for abuseprevention must refer to and appropriately include Harrow Council’s Safeguarding Adults procedure, particularly around ascertaining who would undertake investigations of allegations. Management must ensure that all worn carpeting, including near the kitchen, is replaced. The WC along the main corridor downstairs is in need of some DS0000017515.V325618.R01.S.doc 30/04/07 15/04/07 30/04/07 15/04/07 15/05/07 15/04/07 15/04/07 30/04/07 30/06/07 30/06/07 Page 30 Abbotsford Version 5.2 16 OP25 13(4)(a) 23(2)(a) 17 OP30 18(1)(c) 18 OP38 23(2)(c) 19 OP38 16(2)(j) 20 OP38 13(4) refurbishment due to flaking paint around the washbasin, and the flooring being worn. Radiator covers must be fitted to all exposed radiators. Previous timescales of 01/09/05 and 31/3/06 not met. Management must ensure that (update) training in the areas of emergency first aid, manual handling, and food hygiene, is suitably provided to all staff who have not had such recent training. Management must ensure that professional checks of the portable electrical appliances and the fire alarm system are kept up-to-date. A designated wash-hand basin must be suitably fitted within the kitchen, as per Environmental Health advice. Management must ensure that the water from hot taps available to residents is kept to a suitable maximum temperature. 01/07/07 30/06/07 30/04/07 30/04/07 30/04/07 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 OP3 Good Practice Recommendations Consideration should be given to enquiring further about life histories within the assessment process of a new resident, if they and their representatives are willing, to better inform the home about needs and abilities of the prospective resident. Management should ensure that individual residents’ summary health-consultation grids are kept up-to-date. It is recommended that records of homely remedies being DS0000017515.V325618.R01.S.doc Version 5.2 Page 31 2 3 OP8 OP9 Abbotsford 4 5 6 OP29 OP30 OP31 7 OP35 administered to residents be within the medication files, so that they can be easily accessed and overviewed. For ease of checking, it is recommended that the start date be included in the recruitment file of each staff member. It is recommended that a minimum of three days’ paid training per year be provided to each staff member. Consideration should be given to formally checking that the manager’s advanced certificate in care management meets the expectations of Skills for Care, the national training organisation. It is recommended that there be clear entries within residents’ finance records, of when audit checks are made. Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Abbotsford DS0000017515.V325618.R01.S.doc Version 5.2 Page 33 - 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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