Inspection on 20/11/07 for Abbotsford

This inspection was carried out on 20th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbotsford 13/02/07

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 09:30 20 and 27th November 2007 th 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 DS0000017515.V351703.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. DS0000017515.V351703.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 DS0000017515.V351703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2007 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 receipt of pre-inspection paperwork (the AQAA). 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. People 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 £475 to £510 at the time of the inspection. The Service User Guide is available in the home’s entrance hall, and on request. DS0000017515.V351703.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager kindly provided the CSCI with a detailed Annual QualityAssurance Assessment (AQAA) document in advance of this unannounced inspection. Surveys were then sent to the manager to distribute. At the time of this inspection, eleven resident surveys, ten relative/advocate surveys, three health professional surveys, and four staff surveys had been received and considered. Some additional surveys were received afterwards. Their comments are included throughout the report, and are much appreciated. The inspection took place across one day in mid-November. It lasted just under six hours in total. It included meeting with staff and residents. This process was supported by an Expert-by-Experience, someone who has experience of using care services. They provided the inspector with feedback of their findings at the end of their visit, and a report following the visit. Their comments are included in many areas of this report. The visit also involved checks of the environment, the viewing of a number of records, and discussions with the manager. Following the visit, the lead inspector requested a further audit of medication from a CSCI pharmacy inspector due to concerns identified in this area. A pharmacy inspector, Mrs Shaw, consequently visited the home unannounced on the 27th November for a medication audit. Her findings are included in this report. She also provided the manager with an immediate requirement form and letter at the end of the visit, to highlight key concerns with medication. The inspectors thank 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. As one relative commented, “We feel that Moss Lane surely is a shining example of how residential homes should be run.” 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 continued low staff turnover. Staff have good knowledge of residents’ individual needs and wishes, and treat everyone welcomingly and respectfully. There was a great deal of positive feedback received about the staff at the home. Comments included, “Caring & thoughtful staff”, “Nothing is too much DS0000017515.V351703.R01.S.doc Version 5.2 Page 6 trouble for them”, and “The home is always welcoming to visitors.” Particular comments about services at the home are included throughout the report. 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 including through staff assistance. The Expert-by-Experience noted that every resident spoken with expressed their contentment with their environment and how pleased they were to live at Abbotsford. For instance, one lady said she used to stay on a “respite basis” but was so pleased that she had been “lucky enough to move in permanently”. Another resident said that living here was “almost like being at home.” What has improved since the last inspection? What they could do better: Shortfalls were only significantly identified with respect to medication systems. A pharmacy inspector was requested by the lead inspector to provide an audit, following concerns arising during the main inspection visit. The pharmacy inspector’s consequent visit and ‘immediate requirement letter’ to the home confirmed that a number of improvements are needed. Key amongst these shortfalls are that: • Medication records are not kept sufficiently accurately and up-to-date, which could result in residents being given incorrect medication or missing medications. DS0000017515.V351703.R01.S.doc Version 5.2 Page 7 • • • The service was not fully aware of what each resident’s prescribed medications are, resulting in inaccuracies on the medication administration sheet including one medication being missed off. Medicines received for residents who self-medicate are not being sufficiently checked on, hence they had in some cases either too much or too little medication. The service’s new medication audits are not sufficient to identify all shortfalls. The CSCI is considering what further actions are needed to ensure that medication shortfalls are addressed. A full list of requirements and recommendations is available at the end of this report. 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. DS0000017515.V351703.R01.S.doc Version 5.2 Page 8 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 DS0000017515.V351703.R01.S.doc Version 5.2 Page 9 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, 3, 4 and 5. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service provides appropriate verbal and written information to help people make decisions about whether they want to move in. Sensitive and individualized assessments of need are undertaken, to help ensure that the home can meet the person’s specific needs and wishes. The service has a strong record of meeting residents’ varied needs. A range of trial visits can be undertaken, depending on what the prospective resident and their representatives want, so that the process of moving in is unhurried and at the prospective resident’s pace. EVIDENCE: The home’s Service User Guide was seen at the last inspection to be appropriate except for one issue. The manager stated that the fee range is now included in the Guide, which addresses that issue. She also noted that the Guide is provided to prospective people in advance of trial visits. The Guide was seen to be available in the entrance hall for anyone’s perusal. DS0000017515.V351703.R01.S.doc Version 5.2 Page 10 All resident surveys confirmed that they received enough information about the home before moving in. Some people noted that the home was recommended by friends or relatives who knew of the services provided. There were written assessment records in place for new residents, generally pre-dating their admission date. This includes social services assessments, and hospital transfer forms, where applicable. The home’s assessments considered the needs of the person, so enabling a professional decision about offering placement to be made. The manager noted that the process is undertaken involving all relevant people such as the prospective resident, family members, and health professionals. The pre-inspection paperwork gave an excellent impression of how the process of choosing a residential home is sensitively and individually handled by the home’s management. Key points include that the process is unhurried, that the support of independent people such as the GP or advocacy service is encouraged, that trail visits are enabled for as long as the prospective resident needs, and that permanent placement only happens if everyone involved is comfortable that the home can meet the resident’s needs. Survey feedback about how well the home meets people’s needs was very complimentary. Relatives and advocates all stated that the home meets residents’ needs, either always or usually, and all resident surveys confirmed that they like living here. One person stated for instance that their relative had only been living at the home a short time, “but she has had excellent attention from all the staff and her confidence and health is improving.” Many people responded to questions about how the home could improve, by stating that no improvements are needed. Conversely, the question on what the home does well was answered in numerous ways, including “everything, from our experience” and “creates a worry-free environment.” Records of a formal meeting between the home, a resident, their representatives, and a social services placing officer, at the end of a trial period for a resident, found feedback to be very positive about the support provided. The manager and the majority of staff have worked in the home for a number of years and are familiar with the needs of older people. They know the residents well and all residents appear well cared for. The surveys received by the Commission, and feedback during the inspection visit including to the Expert-by-Experience, provided a great deal of positive feedback about the services at the home. 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. DS0000017515.V351703.R01.S.doc Version 5.2 Page 11 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, 8, 9 and 10. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service is very strong at ensuring that residents are treated respectfully and personally. Residents’ health needs are well met through the service. Care plans and associated documents sufficiently set out each resident’s support needs. However, the home’s medication systems do not sufficiently protect residents to receive medicines as prescribed. EVIDENCE: There was very positive evidence about residents being treated respectfully. Staff were seen to liaise with residents politely and friendlily. Feedback from all residents spoken with during the inspection was very positive about the staff, particularly their warmth and support. Resident surveys found every respondent stating that their privacy is respected, and that staff listen and act on what they say. Relatives’ surveys fedback very positively about the care provided. Comments included, “My mother is happy there, so this must reflect the care she is DS0000017515.V351703.R01.S.doc Version 5.2 Page 12 getting” and “So much love, support & help always given to by all.” One health professional commented, in terms of what the home does well, “Personalized service. Dignity and care always offered and individuals respected.” The overall feedback and observations enable the standard on dignity to be judged as excellent. The care files of two residents were checked through. Care plans for each person dated from November 2007. 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. Some of a wider sample of care plans contained evidence of involvement or agreement by the resident or their representatives. This involvement helps to ensure that the plans address the needs and wishes of the resident, and so should continue to be encouraged. Care files had basic general, night care, manual handling, and falls risk assessments in place. These provided simple guidance on the support needs of the resident. The falls assessments have been redesigned, to enable clearer assessment to take place and actions to be planned. There was evidence of the actions consequently taking place, according to other records, for instance through acquiring chiropody support. Nutritional assessments, including with respect to diet and weight, are now in place for each resident, to help ensure that concerns in these areas can be proactively addressed. The assessments were appropriately detailed, with information written by the resident in some cases, and showed key care actions. There were also records of monthly weight checks of residents, sample checks of which during the inspection raised no concerns. Similarly, assessments of potential to develop pressure sores, and hence proactively counter this, were now in place as required. The manager reported about one person developing a low-grade pressure ulcer since the last inspection, which had been fully addressed with support from the district nursing team. There were detailed ongoing records of health professional input available for each resident. These included about dentistry, chiropody, the opticians, the GP, and in one case, a physiotherapist. There were also records of flu vaccinations for consenting residents. Those residents spoken with confirmed that staff provide support to acquire input from health professionals if requested or needed. One resident told the Expert-by-Experience about being supported by staff to attend a hospital appointment, and that she “had taken great comfort from this.” Health professional feedback about the home was very positive. Surveys found that residents’ health care needs are always met by the home. Comments DS0000017515.V351703.R01.S.doc Version 5.2 Page 13 included, “excellent care” and that they are “appropriately asked to see residents when unwell.” During the main inspection visit, the lead inspector’s checks of the medications included the finding that one resident had not received a prescribed lunchtime tablet the previous day, as the tablet was still in the medication box and it had not been signed for. The medication systems in the home must ensure that all prescribed medications are offered to residents appropriately. A full pharmacist inspection was carried out following a number of concerns identified during the lead inspector’s visit. Medication administration records (MAR) were consequently audited against medicines held in the home, and findings are included here. Key findings were also communicated to the manager by ‘immediate requirement form’ at the end of the pharmacy inspector’s visit, and by consequent letter. The home has a medication policy, which was updated in June 2007. It was noted that several residents often go out for the day and take their medicines with them. The home’s procedure therefore needs to include how this process is managed safely. The policy for keeping household remedies should include Kaolin and Morphine, which was kept in the home. If residents purchase their own household remedies the home should encourage a discussion, to prevent interactions or adverse effects, whilst still respecting the independence of the resident. It was noticed that a prescribed inhaler for one resident, that was identified as missing from the administration records during the main visit, was now entered on the MAR. However, instructions for use for two other medicines did not match what was being given. When a painkiller is prescribed ‘one or two as required’ the actual dose administered must be recorded so that the doctor can assess whether pain is being managed appropriately. The history of allergy should also be readily available on the MAR chart. When medicines are administered they should be signed against the correct time and not as postscripts, so that auditing can be carried out accurately. There were double entries of administration for a tablet prescribed weekly, which could result in the tablet being given to the resident incorrectly. The MAR were not an accurate/current list of medicines for residents including those who are self-medicating. Several of the medicines on the MAR were not available. Residents who take their own medicines need to have regular reviews and there should be evidence of these in their risk assessments. All medicines must be checked and recorded when received into the home including those ordered for residents who self-medicate. Four care plans were tracked for information on medication. Medicines were not always recorded on admission and it was not easy to find evidence of dosage changes e.g. furosemide and calcium. However, the new admission DS0000017515.V351703.R01.S.doc Version 5.2 Page 14 forms contain a section on medication and a signature is now being obtained to indicate consent, if the home takes responsibility for administration. The home was also in discussion with the GP on a written protocol if blood glucose requires regular testing for any resident. The nurse attending to a resident during the inspection confirmed that training could be arranged on diabetes by the Primary Care Trust. DS0000017515.V351703.R01.S.doc Version 5.2 Page 15 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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service is run in a manner that allows residents to have a significant amount of choice and control over their lives. There is a reasonable provision of activities that are provided in a manner that aims to meet residents’ preferences. There are excellent standards of enabling residents to access the community and keep in touch with family and friends, including through the home being very welcoming of visitors. Home-cooked meals are provided, so enabling residents to follow healthy diets that meet their needs. EVIDENCE: Surveys raised some questions about appropriate provision of activities in the home. Three residents stated that there are appropriate activities sometimes, and one rated this as ‘never’. In comparison, six residents provided positive feedback here through the surveys. Relatives also volunteered this as the most common aspect where the home could improve, for instance, “My mother would benefit from a little more entertainment. She sometimes lacks stimulation.” DS0000017515.V351703.R01.S.doc Version 5.2 Page 16 The Expert-by-Experience’s findings in respect of activities was that they are pitched at almost the right level to suit those residents she spoke with. There was a clear sense of not wanting a regular program, with several residents saying that they did not want to be “cajoled into taking part in things,” but that an occasional activity would be welcomed. Another resident said “we have organised freedom which suits us fine.” The manager noted that there was a quiz afternoon the other day, but none of the residents turned up for it. During the inspection visit, a musician arrived to provide a regular performance. On the other hand, discussions between the inspector and a group of residents during the visit found them to express dissatisfaction with the frequency of visiting entertainers. One noted, “It would be nice to have something every week, to look forward to”. They were not aware of the visiting musician this afternoon, and there was nothing on the notice-board about it. It is recommended to review how activities are made known to residents, so that they can make more informed choices about whether to participate or not. The manager explained that there had been a thorough audit of each resident’s activity preferences during the summer, and that the results had been passed to a newly-appointed activity coordinator who had however unfortunately not been able to continue the work shortly after beginning at the home. An advertisement was out for a new coordinator, which one resident noted awareness of. The manager also noted that a music therapist had been tried at the home with little interest, and that an exercise specialist was due to start working Saturday mornings. There were also Christmas activities planned. In summary, the service at the home has made efforts to better meet the activity needs of residents. Some further fine-tuning is recommended to help enable some residents to feel more satisfied with the activity provision. Residents were seen to have the freedom of the home. There were a number of residents in the lounge areas during the morning, however many chose to stay in their rooms until lunch. One resident told the Expert-by-Experience of their pleasure at being able to “wander in and out of the garden” in the summer, a view that was reinforced by other residents. Survey feedback from relatives and health professional confirmed that the service supports residents to live the life they choose. One person stated that the service is “very flexible, as some residents are regularly taken out.” One resident told the Expert-by-Experience that it was “like living in a nice hotel as nothing was too much trouble for the staff.” One resident stated that many residents have phones in their rooms. 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. DS0000017515.V351703.R01.S.doc Version 5.2 Page 17 Feedback during the visit confirmed that residents are provided with support, where needed, for making trips out locally and for appointments. The manager explained how they now provide one resident with a regular staff member to go out locally with, and how the staff member changes from her uniform for this to provide more-sensitive support. Relative surveys provided excellent feedback about how welcoming the home is to visitors, for instance “it is a very friendly, homely house”, and that the home does well at providing “a good family atmosphere in a pleasant setting.” Every relative survey confirmed that the home always helps their relative to stay in touch. Residents’ feedback about the food provided, both through surveys and during the visit to the inspector and the Expert-by-Experience, was very positive. Comments included, “Lunch is lovely”, ” The food is good”, and “There is always plenty of food”. Relatives’ surveys also praised the food in respect of what the home does well, for instance, “The food is very tasty and cooked with care and variety – always fresh.” Staff noted that they use “fresh ingredients”, which was seen to be the case for the beef stew that was prepared for lunch that day. The stew gave off a pleasant aroma, and lunch was noted to be provided in an appetising manner. The kitchen contained much information about the food and drink preferences of residents, and about any food allergies that staff need to be mindful of. DS0000017515.V351703.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is strong feedback that any concerns and complaints that residents have are listened to and acted on. There are appropriate processes in place at the home to help ensure that residents are protected from abuse. EVIDENCE: Every resident who answered a survey confirmed that they know who to speak with if they are not happy. Nearly everyone knew how to make a complaint. Residents spoken with during the visit confirmed that their concerns are listened to, and that it they were ever unhappy with something they could “speak up and something would be done.” Surveys from other people similarly confirmed that complaints can be made and would be acted on. Comments included that “any concerns are actioned immediately”, and “don’t think a concern has been raised.” The complaints process was previously judged as appropriate. Copies of the complaints procedure are available in the bedrooms of residents and in the Service User Guide. The manager noted that there have been no complaints since the last inspection. There have been none raised with the CSCI during this time. DS0000017515.V351703.R01.S.doc Version 5.2 Page 19 Resident surveys found that everyone feels safe in this home. Specific accident records were in place for when residents are injured or found to have falls. Staff and the manager confirmed that they have had training on abuseprevention. The home’s abuse prevention policy has been updated since the last inspection, and is now more comprehensive, particularly about what constitutes abuse and what initial actions should be taken. It is recommended that there be more clarity about what management will do if an allegation comes to light, including what would happen to an accused staff member pending investigations. DS0000017515.V351703.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 25 and 26. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s physical environment is kept safe, clean and homely. There are pleasant and spacious indoor and outdoor facilities. There is a reasonable amount of equipment to assist residents with independence. Consequently, residents are provided with a comfortable environment. EVIDENCE: Feedback from residents during the inspection raised no concerns about the environment. The Expert-by-Experience noted that all resident spoken with expressed their contentment with their environment. For instance, a couple of the residents said they “regularly walked round the garden” and how much “loved it” because they had both had quite large gardens which they had enjoyed when they lived in their own houses. The substantially-sized garden was well-kept at the time of the inspection visit. DS0000017515.V351703.R01.S.doc Version 5.2 Page 21 Similarly, feedback about the cleanliness of the home was positive, including comments such as “the home is very clean and warm” and “it is always clean.” It was noted from records that most staff have had training on infection control. Clinical waste systems were seen to be in place. The laundry area was seen to have a working washing machine and tumble-drier, and many facilities to uphold infection control procedures. Refurbishment of the kitchen has been finalized 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 home has very large lounge with a variety of comfortable seating arrangements. The décor is very homely and warm. Carpeting in the lounge and hallways has now been replaced, as previously required. Radiator covers were now seen to be in place on relevant radiators. It is recommended that the period-clock in the lounge be repaired so that it tells the right time rather than not working, so that residents have the correct time on display in the lounge. One relative raised concerns about the passenger lift being occasionally out-ofuse. The manager noted that the passenger lift has broken down twice since the last inspection. Despite their best efforts, it had taken three of four days before the engineers had managed to get it working again. In one case, a chair-lift had been installed on the stairs to overcome the difficulties for some residents who live upstairs. However, it then had to be removed on the advice of the fire authority. The manager also noted that with staff support, most residents had been able to use the stairs when the lift was not working. Longterm plans to partially-enable an upgrade of the lift were discussed. These should be acted on as soon as practically possible, to help ensure the independence of people living upstairs. DS0000017515.V351703.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. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff who are overall very experienced, and who have a very warm and resident-centred attitude. There are strong standards of training provided to ensure that staff are appropriately skilled in their work. Staffing numbers meet residents’ overall needs. Recruitment practices sufficiently assist with protecting residents. There is a low rate of staff turnover, the consistency from which also supports residents. EVIDENCE: Resident surveys generally stated that staff are usually available when needed. Staff surveys generally stated that there are usually enough staff to meet residents’ needs. Some staff clarified that shortfalls can occur due to unplanned absences. If so, “We try and allocate someone. If we cannot get extra staff we all work together & help each other in any way we can.” There were seven staff working from the start of this inspection. This included carers, people with cleaning responsibilities, a cook, and the deputy who was present to help one resident attend a hospital appointment. 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 five and seven DS0000017515.V351703.R01.S.doc Version 5.2 Page 23 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. Feedback about staff ability and attitude was very positive, both from the inspection visit and through surveys. For instance, relatives’ surveys found that staff clearly have the right skills and experience to look after people. Comments included, “I think the staff at Moss Lane are first class. They certainly are blessed with great skills & love of their work. I can’t speak highly enough” and “The staff have mostly been there for many years. The continuity helps with the residents.” Feedback to the Expert-by-Experience included that it is “like living in a nice hotel as nothing was too much trouble for the staff”. 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. However, there are also now a further ten staff working towards the level-2 NVQ qualification. Some staff discussed with the inspector about the specifics of some of the assessment processes that this involves. The manager confirmed that since the last inspection, training has taken place in a range of areas including abuse-prevention, manual handling, fire safety, and basic first aid. This has involved most staff attending. There was a notice on display during the visit for a food hygiene update course the following week, which all staff were expected to attend. All surveys received from staff reported that training is sufficient and that they are kept up-to-date. The manager also stated that induction training based on the National Training Organization takes place. Staff surveys all noted that induction processes covered everything they needed to know. One person stated, “for two days I was working with other staff, so I have been explained about the home and clients very well”, which was confirmed by another worker met with during the inspection. 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, two appropriate written references, and two appropriate Criminal Record Bureau (CRB) checks. All had been received in a timely manner. Management continue to occasionally liaise with the CSCI over technical difficulties with acquiring the required legislative checks. This suggests a responsible attitude towards upholding residents’ safety through these checks. DS0000017515.V351703.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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is run by a proven management team of many years’ experience. There are formal and informal quality assurance processes that help to ensure that the home is run in residents’ individual and collective best interests. Where the home is entrusted to look after any resident’s finances, this is undertaken appropriately to ensure that the finances are safeguarded. Health & safety systems in the home are sufficient to protect people there. 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 DS0000017515.V351703.R01.S.doc Version 5.2 Page 25 positive feedback about the management at the home, including that residents clearly know who the manager is. Relatives’ survey feedback includes everyone stating that they are always kept up-to-date with important issues such as if their relative had an accident. There was also positive feedback about the manager from staff, noting that she is supportive and available when needed, and “on the other end of a phone at anytime.” The manager noted that quality assurance questionnaires would be formally forwarded to residents and their representatives in early 2008. This follows a similar process in early 2007. CSCI questionnaires were conscientiously distributed by management for this inspection. There is undoubtedly strong informal quality assurance processes in the home, based on feedback to the inspector from the manager, relatives, and residents. The service adjusts to meet the individual needs and wishes of residents. 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 for any transactions such as newspapers and private chiropody. It was encouraging to see that the service absorbed additional costs when a resident’s money on site ran out, until reimbursement could be made. The manager noted that she makes occasional checks of the money records, and that these records are made available on request to appropriate people such as residents and nextof-kin. The local council’s environmental health department undertook an inspection of some aspects of the home in January 2007. A summary report of this identified only one area for improvement, in respect of fitting a designated wash-hand basin within the kitchen. This was now seen to be in place Professional safety checks were in place and up-to-date for electrical appliances and fire systems. The home has an updated fire risk assessment in place, from earlier in 2007 by a professional fire-safety organization. The report from this had only just been received at the time of the inspection visit. The summary of the report found some actions for the home to address, but nothing of obvious concern. A check of the water from the hot tap in the washbasin near the front door found that it had an appropriate temperature. The manager noted that an engineer was to shortly fit further thermostats where needed, with a clear sign being in place in the meantime where risks presented. DS0000017515.V351703.R01.S.doc Version 5.2 Page 26 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 4 3 4 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X X 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000017515.V351703.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Medication sheets must be kept up to date, current and accurate. 1 OP9 13(2) Previous timescales of 12/10/05, 31/3/06 and 15/4/07 not fully met. Medicines must be recorded accurately when received into the home and when administered. If not administered the correct endorsement must be used. If the dose is variable e.g. 1 or 2 then the actual dose administered must be recorded. This is all to help ensure that residents receive their medication as prescribed. The home’s procedures for ordering, receipt and administration must be reviewed and tightened up to ensure that residents receive their medication as prescribed. The home must know what the current medicine for each resident is. Instructions on packaging must correlate with the prescription, MAR and what is being given. DS0000017515.V351703.R01.S.doc Timescale for action 10/12/07 2 OP9 13(2) 10/12/07 3 OP9 13(2) 01/02/08 Version 5.2 Page 28 4 OP9 13(2) 5 OP9 13(2) 6 OP9 13(2) That audits of medication are expanded to improve medication management and to provide 01/02/08 evidence that residents are receiving their medication as prescribed. That there are regular robust risk assessments of medication for residents who self-medicate 01/01/08 so that they do not stockpile medication and receive their current prescribed medication. That the medication policy is expanded to include procedures for giving medicines when residents are away from the home and the purchase of household remedies by 01/02/08 residents. The home’s approved stock of household remedies should be updated. This is all to help ensure that appropriate procedures that protect residents are followed. 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 4 5 Refer to Standard OP9 OP9 OP9 OP12 OP18 Good Practice Recommendations That the home has sight of the prescription before dispensing and keeps a profile of currently prescribed medication. That staff have training on diabetes. Dates of opening should be written on liquid medicines to prevent them from being used past their expiry date. It is recommended to review how activities are made known to residents, so that they can make more-informed choices about whether to participate or not. It is recommended that the abuse-prevention policy have more clarity about what management will do if an allegation comes to light, including what would happen to DS0000017515.V351703.R01.S.doc Version 5.2 Page 29 6 OP19 7 OP22 an accused staff member pending investigations. It is recommended that the period-clock in the lounge be repaired so that it tells the right time rather than not working, so that residents have the correct time on display. Long-term plans to partially-enable an upgrade of the lift should be acted on as soon as practically possible, to help ensure the independence of people living upstairs. DS0000017515.V351703.R01.S.doc Version 5.2 Page 30 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 DS0000017515.V351703.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!