CARE HOMES FOR OLDER PEOPLE
Abbotsford Nursing Home 8/10 Carlton Road Whalley Range Manchester Lancashire M16 8BB Lead Inspector
Geraldine Blow Key Unannounced Inspection 11th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbotsford Nursing Home DS0000062280.V301327.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 Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abbotsford Nursing Home Address 8/10 Carlton Road Whalley Range Manchester Lancashire M16 8BB 0161 226 8822 0161 226 4430 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) Abbotsford Care Home Limited Ms Sally Ann Hughes Care Home 44 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (40), Physical of places disability (3) Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. The maximum number of service users accommodated shall be 44. Nursing care is provided for a maximum of 34 older people aged over 60 years. Three service users are accommodated out of category by reason of age. When these service users leave, the service user category will revert to old age. One named individual is in receipt of personal care by reason of learning disability. When this service user leaves, the service user category will revert to old age. Minimum nursing staffing levels as specified in the Staffing Notice issued under Section 13 of The Care Standards Act 2000 on 4 July 2005 must be maintained. Staffing for the service users assessed as requiring personal care only must comply with the minimum levels set out in the Residential Forum for Staffing in Care Homes for Older People. As detailed in the Statement of Purpose the home must continue to provide the appropriate level of services to meet the specific social, cultural and and religious needs of the Chinese service users accommodated at the home. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2nd February 2006 8. Date of last inspection Brief Description of the Service: Abbotsford provides accommodation for a maximum of 44 residents. The home is registered to accommodate 34 older people assessed as requiring nursing care. The registered provider is Abbotsford Care Home Limited and the Responsible Individual is Mr Joseph Heiftz. The home is situated in a residential area in the South of the City of Manchester. Local facilities and bus routes are within easy walking distance. There are parking facilities to the front of the property. The building is a spacious detached Victorian house set in its own grounds. The home provides accommodation to a number of Chinese residents. Accommodation is provided on four floors. There are 29 single bedrooms containing a wash hand basin and 11 single
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 5 bedrooms with en-suite facilities. There are 2 double rooms providing en-suite facilities. There are 3 lounge/dining rooms and a designated smoking area. The charges for fees range from £373.54 to £399.10 per week. The Commission for Social Care Inpsection (CSCI) inspection report is available at the home and through the CSCI Internet site. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This report is based on information gathered by Commission for Social Care Inspection (CSCI) since the last inspection on 2 February 2006 and some supporting information received in the pre-inspection questionnaire submitted by the home prior to this visit, and the requirements made at the last inspection. This visit was unannounced and forms part of the overall inspection process and it took place on Tuesday 11 July 2006. The opportunity was taken to look at all the core standards of the National Minimum Standards (NMS) and the requirements made at the inspection on 2 February 2006. This inspection was also used to decide how often the home is to be visited to make sure that it meets the required standards. As part of the visit time was spent with the residents who live at the home, speaking with a visitor to the home, observing how staff work with residents, discussions with the manager several members of staff, assessing relevant documents and files and a tour of the premises was undertaken. The CSCI had not received any complaints since the last inspection. What the service does well:
The home carries out a pre admission assessments before a resident is admitted to the home to make sure that the home can meet the person’s needs. One positive thing about this inspection visit was that residents seemed very settled and content. The relationships between residents and staff appeared to be very good. Staff were seen to be sensitive to individual resident needs and were seen sat chatting to residents. One visitor to the home said, “the staff here are brilliant”. The atmosphere in the home felt laid back and relaxed. The home has an open visiting policy and a visitor spoken to said that he could visit whenever he liked and staff always made him feel very welcome. From observations made and from talking to staff and residents at the home, it appeared that the privacy and dignity of residents was protected and that residents were able to have choice with regard to their every day life. Staff seemed to have a good understanding of individual resident needs and one member of staff said that resident choice is encouraged. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 7 The manager was very visible and approachable and during the inspection she stopped and spoke with any resident that she passed. The residents and staff seemed to benefit from her strong leadership approach and her open door policy. Staff spoken to said that the manager had created a relaxed and friendly atmosphere in the home. In an attempt to improve the service the home has a suggestion box in the main reception area and resident meetings are held about twice a year. A choice of meals was available on request at each mealtime. The chef said that she spoke to the residents each morning regarding the daily menu and alternatives were available if residents did not want what was on the menu. She said that she regularly did a number of different meals to suite individual residents. The manager and staff in the home had a good awareness of the importance of offering activities. Photographs were on display of a party celebrating the Chinese New Year and a recent garden party at the home. Also there were posters advertising a Jamaican day, which included taster food for typical Jamaican dishes, accompanied by Reggae music, a trip to the blue planet aquarium in July and a canal boat trip in August. Also evidence was seen that staff did one to one activities with residents for example going shopping to various places or just sat chatting to residents. Systems are in place to support residents or visitors to make a complaint. Residents and a visitor spoken to confirmed this. The home looked after residents’ monies safely. What has improved since the last inspection?
Since the last inspection 6 bedrooms had been re-painted and re-carpeted. The home had bought 2 new pressure-relieving mattresses and a new electrical hoist for the more disabled residents. Also the appearance to the front of the home had improved by the use of attractive plants and the small front patio area had been used by residents during the recent nice weather. The previous inspection report identified some areas of work within the home that needed improving. The home has taken steps to look at these areas and have undertaken some of the work needed to make the improvements necessary. These included some improvement to the residents care plans and the medication administration in the home. The home had met the required action identified by Greater Manchester Fire Service and detailed risk assessments had been developed. The home had reviewed all the staff files to make sure that all staff employed at the home are suitable to work with residents.
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 8 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. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home undertakes an assessment of prospective residents’ care needs prior to their admission. EVIDENCE: The home had a documented pre admission assessment form to ensure that prospective residents are only admitted on the basis of a full assessment. The manager confirmed that all residents have the pre admission assessment prior to admission and for residents who are referred through Care Management arrangements the home obtains a summary of the Care Management Assessment as well. Following the pre-admission assessment the manager confirms in writing to the care manager that the home is able/not able to meet the residents assessed needs. In addition the home must confirm in writing to the perspective resident the outcome of the pre-admission assessment. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 11 The manager said that trial visits prior to admission to the home are encouraged where possible and this is documented in the Service User Guide. The home does not provide an intermediate care service Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Each resident had an individual plan of care, which promoted privacy, dignity and choice. The systems and procedures for dealing with medicines needed some improvements to protect residents. EVIDENCE: A random sample of care plans were examined. Evidence was seen of ongoing work to improve the documentation of the care planning system since the last inspection. The plans of care were found to be detailed, informative and clearly set out the action that needed to be taken by staff to ensure that all aspects of health, personal and social care needs of the residents were met. It was encouraging to note that privacy, dignity and choice was promoted within the care plans. The plans of care had been reviewed on a monthly bases and updated accordingly.
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 13 As required at the last inspection, evidence was seen that some of the plans of care had been drawn up with the involvement of the residents or their representative and included their signatures where possible. Appropriate assessments had been undertaken on residents, with the exception of a continence assessment. In order to ensure that all residents needs are fully met it is recommended that all residents have a continence assessment on admission In addition the daily record of the nursing care provided was of varying standards. Some entries were detailed and informative, however some entries were vague and lacked detail. In order to ensure that all assessed needs are being met an accurate record of any nursing care provided must be kept. The previous requirement has been reiterated in this report. The recommendation made at the last inspection that the manager gets resident/representative consent to take photographs of pressure sores/wounds had not been met and has been reiterated in this report. Residents were registered with local General Practitioners and had access to visiting healthcare professionals e.g., Dietician, Chiropody, Dentistry and Ophthalmology. This ensured residents were in receipt of appropriate health services necessary to support their health care needs. Medication was examined. The medication file contained a photograph of residents for easy identification and there was a record of specimen signatures of staff responsible for the administration of medication. On examination of the Medicine Administration Record (MAR) sheets some prescribed medication e.g. creams and drink thickeners had not been signed for as being given. In order to provide an accurate audit trail all prescribed medication must be signed for by the person administering them. It was of concern that in particular prescribed “Thick and Easy”, which is used to thicken drinks and soups for residents with swallowingdifficulties, had not been signed for. In order to ensure that residents care needs are being met it is vital that a record is maintained of each drink/soup etc that has been thickened. This includes every cup of tea/coffee/juice/water every time the resident has a drink. It is essential that the person making the drink signs a sheet, this does not have to be the nurse and it does not have to be signed on the MAR sheet, a separate drinks sheet may be constructed for each resident. In addition it is essential that the information for thickening must be accurate. The dietician will give detailed advice and this must be readily available to all that are involved in the preparation of drinks/ food for a resident. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 14 It was noted on numerous MAR sheets that the instructions for use were “As directed by the prescriber”. In order to ensure that the resident receives the medication as intended by the doctor the home must have sufficient information to enable nurses to accurately administer medication as prescribed by the doctor. The doctors’ instructions must be recorded. It is recognised that the GP may not always write sufficient information on the prescription to enable the pharmacy to write anything more than as directed. The pharmacy can only put on the label what ever the GP has put on the prescription. However it is essential for the nurses to obtain sufficient information from the GP so as to administer the medication as directed. This information should be readily accessible for nurses during medication administration. All deliveries and disposal of waste medication had been signed so providing a full audit trial. As required at the last inspection, the temperature of the room where medication was stored had been monitored and was now at an acceptable level. In line with the Royal Pharmaceutical Guidelines the home received the prescritions and took a copy before they were sent to the pharmacy for dispensing so that the home had an accurate reocrd of what the GP had prescribed. This meets the requirement made at the last inspection. It was noted that medication with a limited life had the date of opening documented so ensuring out of date medication is not given to residents. As identified at the last inspection there was still some concern that nurses had altered dose frequency of medication without correct authorisation from the GP. For example it was noted that the dose of eye drops had been altered without evidence of GP authorisation. As required at the last inspection all medication dose changes must be documented and nurses must work within NMC guidelines. As required at the last inspection the home policies and procedures had been further developed to include the misuses identified in the last report. However in line with the Royal Pharmaceutical Guidelines, it is recommended that a policy be implemented that the home must not accept verbal orders of prescriptions and that alterations to existing prescriptions should not be made unless the prescribing GP faxes details of the change to the home. From observations made during the inspection and discussions with members of staff, residents and a visitor to the home it appeared that the nurses and care staff treated the residents with respect and dignity. Abbotsford Nursing Home DS0000062280.V301327.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Activities were provided and residents were able to maintain contact with family and friends. Residents were able to exercise choice and control over their lives and the residents enjoyed the meals that they choose. EVIDENCE: As already stated in this report evidence was seen of organised and 1:1 activities for residents. However t is recommended that an activity co-ordinator is appointed to take responsibility for organising and documenting activities undertaken by residents. It was encouraging to note that a social history was completed on admission to the home and activities undertaken was documented in the daily logs. It is recommended that the home introduce the use of an individual activity record. The manager said that the home facilitated open visiting and visitors could be received in the residents’ own room or any of the communal areas of the home. Discussions with residents, a visitor and staff confirmed this. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 16 From speaking to residents and staff it appeared that residents are able to exercise choice and control over their lives and that residents are encouraged to bring personal possessions into the home. The menu examined demonstrated that the home provided a varied diet, which was nutritionally balanced and adequate supplies of fresh fruit and vegetables were seen. An alternative to the main meal was available at each mealtime and the chef confirmed this. When the chef was spoken to it was evident that she had a good knowledge of the individual needs, likes and dislikes of individual residents. Food stocks were seen in sufficient amounts and were appropriately store off the floor. However it was noted that food stored in the fridge had been covered but the date of opening had not been documented. The chef said that all the covered food had only been put in the fridge after lunch and she said usually put a sticky label on with the date of opening but she had run out of labels. All opened food must contain the date of opening. The home employed the services of a Chinese cook and Chinese meals were provided. In addition at the time of this visit the home were providing Halal and African Caribbean meals. Snacks and drinks were available on request. Abbotsford Nursing Home DS0000062280.V301327.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home encourages and supports people to raise their concerns and complaints and had the policies, procedures and systems in place to protect residents from abuse. EVIDENCE: The home has a complaint procedure, which was on display in the main reception area, and a copy was included in the Service User Guide, which every resident had been given. The visitor to the home said that he had never made a complaint but if he had any concerns he would go to the deputy manager and he felt she would take his concerns seriously. The home maintained a complaint file, which contained details of the complaint, staff statements, the actions taken and the outcomes. Since the last inspection the home had received one complaint that had been appropriately dealt with. The home had policies and procedures in relation to protection of adults from abuse and Whistle Blowing. The home had a copy of the Manchester MultiAgency Policy on the Protection of Vulnerable Adults from Abuse. During discussions with the manager and staff it was evident that not all of the staff had received training relating to the Protection of Vulnerable Adults. In order
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 18 to protect the residents living at the home all staff must receive Protection of Vulnerable Adults Training, which includes the actions to be taken in the event of an allegation of abuse. Abbotsford Nursing Home DS0000062280.V301327.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Further improvements had been made to the homes décor in order to provide clean, comfortable surroundings for residents. EVIDENCE: As already stated in this report, a number of improvements had been made to the décor and furnishings within the home. The manager stated that is was a continuing area of development. Generally the home was clean and comfortable for residents. The visitor spoken to said that he had seen great improvements to the décor and cleanliness of the home in the last 12 months. Although improvements were seen within the home some areas were still in need of improvement. For example several bedroom carpets were seen to
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 20 stained and several items of bedroom and dining room furniture was seen to be showing signs of age and general “wear and tear”. The manager said that the internal refurbishment of the home was continuing on an ongoing basis. As already referenced in this report the garden area was not utilised to its full potentional. At the time of the inspection the patio areas were found to be unsuitable and unsafe for the residents to use. The rear patio areas had weeds growing through the flags and one area in particular had items of rubbish stored and old, poor quality indoor furniture, which was not appropriate for outdoor use. It is recommended that the garden and patios be made safe and available for residents use and that the home purchase some suitable patio furniture. In addition, as already identified in this report, the clinical waste and general rubbish bins must be stored in a safe enclosed area so as not to pose a risk to residents. There is a conservatory to the rear of the building, which is cluttered and unattractive in appearance. The manager said that is was not used for residents as access could only be gained via the kitchen, although there are patio doors leading out onto the patio area. Therefore, as recommended in this report, if the patio area was made safe and accessible for residents to use access could possibly be gained to the conservatory via the patio, if a small ramp was fitted, as there is a step up into the conservatory. Therefore it is recommended that the conservatory is cleaned and made attractive and possibly made accessible for residents to use via the patio area. Laundry facilities are sited away from the food preparation area. The home had policies relating to infection control and it was noted that bathrooms and toilets had wall mounted paper towels and pump soap dispensers in line with the latest Infection Control Guidelines. The manager said that residents who required the use of the hoist or a slide sheet had their own sling/slide sheet in an attempt to prevent cross infection. In addition each resident had a basket containing their own toiletries that was taken to the bathroom with them and returned to their bedroom after use. These are all seen as good practise. Generally the wheelchairs were seen to be of an acceptable standard of cleanliness, however a small number were seen to be rather “grubby” in appearance. This was discussed with the manager who said she would implement a rota for the regular cleaning of wheelchairs. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The number and deployment of staff appeared sufficient to meet the residents’ assessed needs however the home was unable to demonstrate that its staff had completed the required training to meet resident’s needs. The procedures for recruiting staff were robust and provided adequate safeguards to protect residents. EVIDENCE: The manager said that she was currently in the process of recruiting 2 new members of care staff. Due to the recent shortage of care staff the manager had been delivering hands on care on many of her shifts to make up for the shortfalls. However she was on the point of starting one new carer and the recruitment procedure was almost complete for the other carer. As identified at the last inspection the manager said that she did regularly review the dependency levels of the residents to ensure that sufficient staff were provided to meet their assessed needs. However, the manager said that she could not provide evidence that the reviews had taken place. Therefore the requirement has been reiterated in this report. The home employs 17 carers and 11 members of care staff have successfully achieved NVQ Level 2.
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 22 The staff files examined contained the appropriate documentation as required by Schedule 2 of The Care Homes Regulations 2001, with the exception of one file that did not contain a staff contract. The manager said that she would chase this up immediately as all staff had been given contracts to sign. Evidence was seen that the manager was in the process of implementing an individual training and development plan for staff. However at the time of this inspection they were not complete so evidence could not be provided that staff had undertaken the necessary mandatory (including refresher) training. In order to protect the residents living at the home the proprietor must ensure that appropriate training is made available for all staff. The manager had recently produced a structured induction process based on TOPPS, however from September 2006 a new Induction Module programme is being introduced by Skills for Care (formerly TOPSS). It is recommended that the home take account of the new requirements and include them in their induction programme. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Systems and procedures were in place, which safeguards and protects residents’ financial interests. The home does not have the systems in place to monitor the service based on people’s views and all areas of the home were seen to promote the health, safety and welfare of the residents and staff. EVIDENCE: As identified at the last inspection the residents in the home benefit from a committed manager and the further development of a staff team with a positive attitude. The manager operates an open management style and encourages residents, visitors and staff to make use of the ‘open door’ policy.
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 24 At the heart of this style of management is a person centred approach where the focus is on how the individual resident wants their care needs to be met. The manager had recently received her NVQ Level 4 certificate in Management. The residents and staff spoken to during the course of this inspection expressed satisfaction on the way the home was run and the quality of the services delivered by the staff in the home. The manager said it was her intention to develop a quality audit questionnaire to review the quality of the service being delivered. It is recommended that the questionnaire be sent to residents, relatives and visiting professionals in an attempt to gain their opinion of the quality of the service. It is then recommended that the manager produce an annual development plan based on the results of the quality assurance questionnaire. It was encouraging that the home had a suggestion box situated in the main reception. However the manger said that they had not had any suggestions to date. Residents meetings are held approximately twice a year and minutes are taken. At the time of this visit the manager was in the process of reviewing and updating all the homes policies and procedures. The manager said that the policy file was accessible to staff at all times. Since the last inspection the manager had developed a supervision procedure and the paperwork to facilitate formal supervision. Now the paperwork is in place it is her intention to implement formal supervision 6 times a year and an annual appraisal. This will be beneficial to the staff. The manager said that where possible residents or their representatives are encouraged to manage finances. Where this is not possible the administrator maintains a running balance, written transactions are maintained and receipts are kept for all purchases made on behalf of a resident to ensure that monies are effectively managed. Evidence was provided that the home’s maintenance certificates and records were up to date in order to protect the residents and staff employed. However it was of some concern that the testing of water temperatures had not been recorded since November 2005. The issue was discussed with the manager and the maintenance person during this visit, who assured the inspector that testing would be implemented immediately. To ensure the safety of residents and staff the proprietor must ensure that the home consistently carries out water temperature testing. A random test of the water temperatures conducted by the inspector ranged from 25.4oC in the bathroom on the top floor to 45.4oC in the bathroom next to room 203. To ensure the health and safety of residents and staff are protected at all times the registered provider must ensure the temperature of water delivery must be close to 43oC but no more than 44oC. Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 25 Evidence was seen that the areas of non-compliance identified by Greater Manchester Fire Authority 19/01/06 had been addressed and fire risk assessments had been implemented as required at the last inspection. Fire safety checks had been regularly undertaken and the last fire lecture was undertaken on 23 January 2006. The last fire drill was January 2006 and a further fire drill had been scheduled for 12 July 2006. Abbotsford Nursing Home DS0000062280.V301327.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 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 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 2 X 2 Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement Following the pre admission assessment the home must confirm in writing, to the prospective resident, that the home is able/not able to meet their assessed needs. The proprietor must ensure that an accurate record is kept of any nursing care provided to the resident, including a record of his/her condition and any treatment. (Previous timescale of 2/3/06 had not been met). The proprietor must make arrangements for the recording, handling and safe administration of medicines which are detailed below: 1. All medication dose changes must be documented and nurses must wok within the NMC guidelines. (Previous timescale of 31/3/06 had not been met).
Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 28 Timescale for action 08/08/06 2. OP7 17 Sch 3 01/08/06 3. OP9 13 08/08/06 2. All prescribed medication must be singed for. 3. The home must have sufficient information to enable nurses to administer medication as prescribed by the doctor. The doctors’ instructions must be recorded. 4. It is vital that a record is maintained of each drink/soup etc that is thickened 4. 5. OP15 OP18 13 13 Opened food in the fridge must contain the date of opening. Evidence must be provided that all staff have received Protection of Vulnerable Adult Training, which includes the actions to be taken in the event of an allegation of abuse. To ensure the health and safety of residents and staff are protected at all times the registered provider must: 1. The stored rubbish to the back of the home must be removed. 2. The general waste and clinical waste bins must be stored in an enclosed area 7. OP27 18 The manager must provide evidence that the dependency levels of the residents are regularly reviewed to ensure the staffing levels are sufficient to meet the assessed needs. (Previous timescale of 2/3/06 had not been met). 8. OP30 18 Evidence must be provided that all staff have undertaken the necessary mandatory (including refresher) training and have an
DS0000062280.V301327.R01.S.doc 12/07/06 01/10/06 6. OP19 13 31/08/06 31/08/06 31/08/06 Abbotsford Nursing Home Version 5.2 Page 29 individual staff training and development plan. 9. OP36 18 Evidence must be provided that staff working at the home are appropriately supervised. (Previous timescale of 31/8/05 and 31/3/06 had not been met). 10. OP38 13 To ensure the health and safety of residents and staff are protected at all times the registered provider must: 1. Ensure the temperature of water delivery must be close to 43oC but no more than 44oC. 2. The home must consistently carry out water temperature testing. 12/07/06 31/08/06 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 OP8 Good Practice Recommendations 1. In order to ensure that all residents needs are fully met it is recommended that all residents have a continence assessment on admission. 2. It is recommended that the manager gets resident/representative consent to take photographs of pressure sores/wounds. In line with the Royal Pharmaceutical Guidelines, it is recommended that a policy be implemented that the home does not accept verbal orders of prescriptions and that alterations to existing prescriptions should not be made unless the prescribing GP faxes details of the change to the home.
DS0000062280.V301327.R01.S.doc Version 5.2 Page 30 2. OP9 Abbotsford Nursing Home 3. OP12 1. It is recommended that the home employ the services of an activity co-ordinator. 2. It is recommended that the home introduce the use of an individual activity record for residents. It is recommended the conservatory IS cleaned and made attractive and that the proprietor give some consideration to making the conservatory accessible for residents to use via the rear patio area. Skills for Care have introduced new requirements for staff induction and training. The manager should take account of the new requirements and review and revise their induction process. 1. It is recommended that the manager develop a quality assurance questionnaire that is sent to residents, visitors to the home and to visiting professionals in order to obtain their views of how the home is achieving goals for residents 2. On receipt of the results of the quality assurance questionnaire it is recommended that the manager produce an annual development plan based on the results. 4. OP19 5. OP30 6. OP33 Abbotsford Nursing Home DS0000062280.V301327.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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