Inspection on 25/01/07 for Abbotsleigh Mews Nursing Home

This inspection was carried out on 25th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abbotsleigh Mews Nursing Home 21/09/07

Abbotsleigh Mews Nursing Home 28/11/05

Abbotsleigh Mews Nursing Home 08/06/05

Abbotsleigh Mews Nursing Home 23/11/04

Abbotsleigh Mews Nursing Home 12/07/04

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 Abbotsleigh Mews Nursing Home Old Farm Rd East Sidcup Kent DA15 8AY Lead Inspector Maria Kinson Unannounced Inspection 25th January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.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. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsleigh Mews Nursing Home Address Old Farm Rd East Sidcup Kent DA15 8AY 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) 020 8308 9590 020 8308 9540 lawrenja@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited Ms Janet Lawrence Care Home 120 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. One service user on the Macmillan House, can be over the age of 40 years. The Manager of the home must notify the Commission in writing, (without delay) when any of the 5 service users named in the letter dated the 18/07/2006 move from the Berens Unit. Macmillan House will provide nursing care to people with Old Age, 30 places. Berens House will provide nursing care to people with Dementia, 30 places. Smythe House will provide Personal Care to people with old age, 30 places. Calvin House will provide personal care to people with Dementia, 30 places 28th November 2005 Date of last inspection Brief Description of the Service: Abbotsleigh Mews is situated in a residential area of Sidcup, within walking distance of bus routes and a railway station. The home is purpose built and consists of four separate units, each of which is registered to provide care for up to 30 residents. The ground floor units are Calvin House, which provides personal care to residents with dementia and Macmillan House, which provides nursing care. The first floor units are Berens House, which provides nursing care for residents with dementia, and Smythe House, which provides personal care. Administration, catering and laundry facilities are centrally located within the home. All bedrooms in the home are for single occupancy and have ensuite facilities. Residents have access to the homes grounds and there is a separate secure patio/garden area for people living in Calvin House. There is a car park for staff and visitors. The fees charged by the home range from £450 - £850 per week. This does not include additional charges such as chiropody, hairdressing and newspapers. This information was supplied to the commission on 29.11.06. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 25/01/07 and was unannounced. Three inspectors spent most of the day on Calvin, Berens and Macmillan talking with residents, staff and visitors, observing care practices and examining records. The Pharmacy inspector visited all of the units in the home to assess the management of medication. Twenty- one relatives provided written information about the service and the inspectors spoke with six visitors during the inspection. In the period since the last inspection the home had applied to the commission to change the registration category on Berens. The application was assessed and approved. This unit is now registered to provide nursing care for older people with dementia. What the service does well: Residents were able to take part in a varied programme of activities. Activity staff were enthusiastic and motivated. Residents were satisfied with the quality and choice of food provided and said there was always plenty to eat. Residents that were unwell were referred to the GP and support and advice was obtained from community nurses and other health care professionals when required. Most residents and relatives were satisfied with the care provided in the home. Some relatives said that their family member had improved since moving into the home and others said that their relatives were receiving “the best possible care”. Residents said that staff were “extremely courteous” and helpful and respected their decisions and choices. All parts of the home and grounds were clean, tidy and well maintained. Resident’s rooms were homely and comfortable. Visiting times were flexible. Relatives could visit the home at any time and were made to feel welcome. Complaints and concerns were investigated promptly and all grades of staff received adult protection training. Care was taken to safeguard resident’s money. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 6 Residents received care from staff that they were familiar with and that understood their needs. All grades of staff had access to vocational and ongoing training courses. Staff said that training sessions helped them to learn new skills and meet resident’s needs. Thorough checks were carried out when recruiting new staff and adequate documentation was obtained. The recruitment procedure operated by the home ensured that suitable staff were appointed and residents were protected from harm. The home was well organised. Staff were aware of their role and responsibilities and communicated effectively with their colleagues. Relatives said that senior staff were “down to earth” and “good listeners”. The service was assessed regularly to ensure that staff followed procedures and met recognised standards. Feedback was obtained from residents and relatives to identify good practice and areas for improvement. What has improved since the last inspection? All of the requirements made at the last inspection had been addressed. The shower room and call bell on Macmillan had been repaired and was in working order. The staffing levels on Beren’s and Calvin had been reviewed and increased to reflect the higher levels of dependency and time required to care for people with dementia. Residents had their own supply of washing creams or lotions. Wheelchairs were clean and well maintained. The registration category for Beren’s had changed to reflect residents needs. Most residents were able to continue living in the home if their needs changed or they developed dementia. Some staff had attended a four-day dementia training course and plans were in place to provide similar training for other staff. Most of the care plans seen were good and plans about wound care and residents social needs had improved. Some residents had a key to their room and were able to lock their door when they left the room or went out. Staff had labelled keys to reduce the risk of them becoming mislaid. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 7 There were call bells in all of the rooms and residents said that bells were usually answered promptly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.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 Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.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 and 3. (Standard 6 does not apply to this home). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff carried out a care needs assessment before confirming that the home could meet resident’s needs. Some assessments did not provide adequate information for staff. EVIDENCE: Information for residents was provided in the Service User Guide. Copies of this document were seen in resident’s rooms. Senior staff were responsible for assessing residents care needs and deciding in discussion with the manager if prospective residents needs could be met in the home. Three pre admission assessments were viewed for residents that had been admitted to the home in recent months. The information recorded on the pre admission assessment sheet was variable. Some of the assessments seen were very informative but the information that was obtained Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 10 in respect of residents admitted to the residential unit for people with dementia was very basic. All of the questions on the assessment sheet were answered but where needs such as short- term memory loss or confusion were identified there were no indications about how this was affecting the resident or what strategies staff could use to reassure the resident. See recommendation 1. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the care plans seen reflected resident’s needs but some plans were old or did not include important information about the use of specialist aids and equipment. Staff worked in partnership with other professionals to meet resident’s health care needs. The management of medication was mostly satisfactory but a small number of record keeping issues were identified. Residents said that staff treated them with respect and maintained their privacy and dignity. EVIDENCE: The inspectors examined six sets of records. Most of the care plans examined were good. In particular information about pressure sores and wound management was up to date and easy to follow. The records showed that wound plans were followed and clear information was recorded about how the Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 12 wound was progressing. A number of the records seen were person centred. For example one plan stated that a resident liked the curtains left open and the lamp left on of a night and said that the resident preferred to remain in his room. Another plan advised staff about the residents preferred bedtime routine and stated what time the resident liked to go to bed. Care plans were reviewed regularly and some of the plans seen were agreed and signed by residents or relatives. Some care plans were developed in 2004. Staff acknowledged that resident’s needs had changed since the plan was developed. Although changes were recorded in the evaluation records the care plan was not always fully updated. Some of the care plans seen did not include important information for staff such as ensuring that hearing aids were inserted and were in working order and the about use of pressure pads. See recommendation 2. Staff had carried out a number of assessments to identify risks to residents and staff. Assessments indicated if residents were at risk of developing pressure sores, falling or becoming malnourished. If staff identified a potential risk a care plan was developed to advise staff about what they should do to maintain residents safety. Residents were registered with a GP and were supported to access other community healthcare services. Advice was obtained from other professionals such as the Tissue Viability Nurse and Diabetic Nurse when required and some professionals visited the home regularly. A record was kept in the resident’s care records about contact with other professionals. Equipment was provided in relation to the prevention and treatment of pressure sores. Storage facilities and medication records were inspected on each of the four units. Although most of the requirements made about the management of medication at previous inspections had been addressed, some issues had recurred. Requirement 1. Medication handling was acceptable in most cases but there were a small number of recording issues that must be addressed. This included records of: receipt of medication, medication carried forward from the previous month, administration and changes to the dose or frequency that were not initialled and dated. See requirement 2. All medicines were in stock and staff received appropriate training, including competence assessments. The temperature of one drug refrigerator was above 8C on occasions. There was no evidence that advice was sought to check if the medicines were still suitable for use. An issue was notified in writing to CSCI in December 2006 relating to a discrepancy in stock of a Schedule 2 Controlled Drug. This discrepancy was first noted in January 2005 but took several months to investigate. The investigation was complete, and the reason for the discrepancy was identified. Home staff had not filled in the controlled drug register when the drug was Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 13 issued to a Community Nurse and no records were made of the treatment given. The community nurses records, located in January 2007 showed that the drug had been used. As a result of this incident the manager had introduced a new form for district nurses and other community staff to complete before leaving the home. The form indicates which residents they assessed and what treatment, if any, they provided during their visits. All bedrooms were single occupancy. Staff were observed knocking on doors before entering bedrooms. Bathroom doors had locks fitted and care plans seen addressed the need for privacy when bathing residents. Residents said that staff were polite and respectful, that call bells were usually answered promptly and that meals were good. They also said staff asked them what they wanted to wear and where they wanted to spend their day. One resident that had been in hospital recently said “I could not wait to get back to the home”. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were supported to undertake a varied and interesting programme of activities. Visiting arrangements were flexible. This helped some relatives to maintain regular contact with their family member. Residents were able to make choices about how and where they spent their time but were not always able to choose what they ate. Residents were satisfied with the choice, variety and quality of food provided in the home. EVIDENCE: All of the units had a dedicated activities person. Activity staff organised a varied range of activities and social events. Since the last inspection some of the units had held dances where family members were invited, a garden party in the summer, and social events to mark events in the calendar year such as St Patrick’s Day, Valentine’s Day and Easter. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 15 On Calvin staff had performed an Old Time Music Hall show and led karaoke sessions. There was a small lounge furnished and decorated as an old fashioned sitting room, with a false mantelpiece, armchairs, ornaments and pictures. In the warmer weather residents visited local garden centres, grew sunflowers and vegetables and occasionally went out for a pub lunch. The home has no transport for residents, so they use Dial-a Ride, which can only take two residents in wheelchairs. A dedicated minibus for the home would increase opportunities for residents to have regular outings. On Smythe two pianists were entertaining residents in the lounge with a selection of popular song tunes, such as, “Pennies from Heaven” and “A Nightingale Sang in Berkeley Square”. Some residents were singing along, or tapping their feet. Carers who were present were attentive to residents’ needs, closing the curtains when the sun shone in brightly, and adjusting a resident’s feet on the footplate of the wheelchair. On Berens the activity person was supporting residents to paint and complete puzzles. Most of the residents on this unit had limited concentration but the staff member managed to support a large group of residents and maintain their attention for a significant period. The activity coordinator was constantly interacting, supporting and reassuring residents during the session. Once a fortnight there was a religious service for those who wanted to participate. There was a ‘resident vicar’ who could be contacted at any time, and visited residents in hospital. There was a hairdressing room in the administration block that operates four days a week. Staff made a record of resident’s who wanted to visit the hairdresser and provided an escort service when required. Residents said they liked visiting the hairdressers and enjoyed having a chat and cup of tea or coffee in the salon. Activity staff were motivated and enthusiastic. An activity folder was maintained to record the type of activity that had taken place and the names of residents that had taken part. Lunch was observed on Macmillan, Berens and Calvin. Most of the residents had their meal in the dining area but a small number of residents ate in their room through choice. Tables were properly laid with tablecloths, napkins, condiments and drinks. The menu was varied and well balanced. On the day of the inspection there was – navarin of lamb, sausage plait or kedgeree. Residents were seated for lunch and meals were served from a heated trolley. Some residents required pureed food. Each item was served separately on the plate on all of the units except Berens. On Macmillan the pureed meal looked rather dry for residents with swallowing difficulties and no extra gravy or sauce Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 16 was supplied. Some residents were asked what they would like to eat, but staff made choices for a number of the residents on Macmillan and Calvin. Staff said, “We know what they like” and said that some residents become anxious if they were given too much choice. Residents on Macmillan said that they normally had a choice of meal. There was no visual cue for residents such as a menu, and staff did not always provide this information. Staff did engage with residents when they put the food in front of them, and encouraged residents to hold the spoon and feed themselves. One resident who left the table was gently persuaded back to her chair. Some residents were asked if they wanted salt and pepper and drinks were provided. Staff provided sensitive assistance with feeding but one staff member did not respond promptly to residents needs. The manager addressed this issue promptly. Residents spoken with said they enjoyed their food and were satisfied with meals provided. See recommendation 3. In the office there was a colourful poster advertising the ‘Night Bite Menu’, which was available at all times when the main kitchen was closed. Each unit had a satellite kitchen to prepare these snacks, and the sister on Calvin confirmed that fruit, cereal, toast and spreads, cakes, biscuits, sandwiches and beans could be provided to residents upon request. There was a large bowl of fruit in the kitchen. Relatives said they could visit the home when they wanted and were made to feel welcome. 90 of relatives said they were kept informed about important matters, were consulted about their family members care and were satisfied with the overall standard of care. Relatives that the inspectors spoke with during the inspection did not raise any concerns about the service but said that activities could be improved. Residents said that food was good, staff were kind, polite and respectful and the call bell was usually answered in good time. Regular meetings were held on each of the units for residents and relatives and the main issues discussed were recorded and displayed for relatives or residents that were not able to attend. Some of the residents on Calvin had keys to their bedrooms, and one resident was seen locking the door as he left. The keys were marked with the resident’s name, in case they got mislaid. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place for staff to follow when investigating complaints or concerns. All grades of staff received abuse training and were aware of adult protection issues. EVIDENCE: The complaints procedure was displayed in the home and was included in the Service User Guide. 84 of relatives said they were aware of the homes complaints procedure and would know who to speak to if they had concerns. The home had received seven complaints about invoices, communication, response to call bells and personal care issues during the past year. Complaints were logged in a file and were investigated promptly. A record was maintained about the number of complaints that were received each month. This made it easy to see at a glance if a particular unit was receiving more complaints than other units or if there were any similarities in the concerns raised. To avoid confusion a code should be used to identify complaints that are recorded in one month and carried forward into another month. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 18 The commission had received one complaint about the care received by a resident some years ago; this complaint was sent to the provider to investigate. One concern is currently being investigated under the local authority adult protection procedure. There is no evidence at this time that staff from the home had any involvement in this issue. Care staff had a good understanding of adult protection procedures and were very knowledgeable about the needs of the residents they key worked. Most staff had attended protection of vulnerable adults training during induction and regular updates were provided for all members of staff including maintenance and domestic staff. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a comfortable and welcoming environment for residents and their visitors. Most areas were clean and tidy but some work was required on one unit to ensure adequate odour control. The laundry service was well organised and efficient and staff followed procedures to prevent cross infection. EVIDENCE: On Calvin bedroom doors were blue or yellow, and toilet doors were painted red to make it easier for residents to locate these facilities. Outside each bedroom door there was a memory box, fixed securely to the wall, with a small selection of photographs, cards and ornaments that were of significance to that Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 20 person. This is a good orientation tool for the residents themselves, and reminds staff and visitors alike that residents are people who have led full and varied lives. Although most of the residents on Berens were not able to move around the home independently some work should be undertaken to maximise independence and aid orientation. See recommendation 4. All of the parts of the home were well maintained, clean and tidy but there was some odour in the corridors and lounge on Calvin. See requirement 3. The dining tables on Calvin had a ridge around the edge of the table, which trapped food and dirt. Domestic staff must ensure that this area is kept clean. Bedrooms were clean with the exception of bedroom 36 on Macmillan. The carpet in this room required cleaning. Staff said that this carpet was cleaned daily to minimise odours and keep the room fresh. Bedrooms seen were nicely personalised with pictures, photographs, ornaments and small items of furniture. A requirement made at the last inspection in relation to repairs required in the shower room and to a call bell on Macmillan had been met. The grounds and gardens at the front of the property were maintained to a very high standard. The rose beds and lawns were immaculate and there were plenty of areas where residents and relatives could sit and relax. Some residents said they enjoyed the view from their window. The home has two maintenance technicians. Staff recorded repairs in a book on the units. The book was checked daily and signed once the work was complete. The records indicated that most jobs were completed within 24 hours. Call bells were fitted in all of the units. Some of the residents on Calvin that were unsteady or had frequent falls had a pressure mat, on the floor next to the bed, to alert staff when they were getting up. This equipment was connected to the pagers carried by staff. The laundry was sited away from the units and kitchen and was appropriately staffed. All of the machines were in working order and had a sluice programme. Resident’s personal clothing, linen and towels were all laundered on site. Laundry was completed unit by unit to reduce the risk of personal clothing getting lost. Staff had access to a labelling machine and ensured that clothes were labelled with the resident’s name. Soiled laundry was placed in red soluble bags and placed directly into the washing machines. The laundry flooring was impermeable and staff had equipment suitable for moving large quantities of clothing. The laundry seen on all of the units was extremely well presented, with blouses and jumpers pressed and hanging on hangers. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 21 All staff, both in the laundry and on the units, had access to protective clothing. Hand washing facilities were provided where waste was handled. An environmental health officer inspected the main kitchen in September 2006. The kitchen was awarded a ‘Silver Clean Food Award’ following this visit. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a stable team of staff. This provides good continuity of care for residents. Residents were protected by the homes recruitment procedure. All grades of staff were encouraged to update their knowledge and skills and attain relevant qualifications. EVIDENCE: The off duty roster indicated that residents received good continuity of care. The number and skill mix of staff varied from unit to unit but staffing levels had been reviewed and increased on Berens and Calvin to reflect an increase in resident dependency. Three staff recruitment files were examined. Adequate documentation and checks had been obtained and carried out prior to allowing new staff to commence work in the home. 52 of care staff had completed a vocational qualification in care at level two or three. This exceeds the recommendations made by the Department of Heath. Twenty-three carers were currently undertaking vocational qualifications. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 23 The training coordinator was responsible for assessing staff training needs and ensuring that staff had access to relevant training sessions. New staff attended a two-day induction-training course and completed an induction workbook that covered all of the core induction standards. Records were maintained about training that staff had undertaken. Some of the senior staff had attended a four-day dementia course. Staff said they had found the course very useful. A two-day dementia course had been arranged for the remaining staff using the information obtained during the four-day course. Since the last inspection some members of staff had attended fire safety, Liverpool Care pathway, moving and handling, food safety, infection control, abuse, bedrail and challenging behaviour training sessions. Staff were satisfied with training arrangements and said that sessions were relevant to the work they were undertaking and helped them to meet residents needs. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home was well managed and led. There were good systems in place to monitor and improve the standard of care provided in the home. Care was taken to keep residents money safe and to account for its use. Arrangements were in place to identify and address health and safety issues promptly. EVIDENCE: Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 25 The manager has a nursing qualification and completed the registered manager’s award in 2005. Staff said that the manager and deputy manager visited the units regularly to support staff and monitor care practices. The home had a comprehensive quality assurance system. The system included monthly audits of specific topics such as medication, record keeping and health and safety. The quality manager checked the findings from audits to ensure that they were accurate and that appropriate action was taken to improve the service. The home obtained feedback from residents and relatives during meetings and a satisfaction survey was sent out to relatives each year. Staff had started to request feedback from residents or relatives on a monthly basis. This initiative will help staff to address concerns in a timely manner. A policy and procedure was provided in relation to the management of resident’s personal finances. The administrator was responsible for maintaining adequate records and keeping residents money and valuables safe. Some residents were able to spend money themselves and in these cases were not expected to produce receipts but signed to confirm that they had received money. Personal money was held in individual named residents accounts enabling interest made to be paid to the resident. Records for two residents were checked and were found to be correct. The maintenance technician had attended fire marshal and lifting equipment training and was therefore able to provide fire safety training for staff and to undertake interim checks on hoists and lifting equipment. Safety records viewed included portable appliance testing; lift service, gas safety and electricity. All of the records seen were well maintained and up to date. The fire alarm system and emergency lighting were regularly serviced and the fire alarm was tested once a week. Two fire drills were held on each unit during a twelve-month period. The drills were carried at various times of the day so that both day and night staff were involved. Records also showed that regular checks were carried out on items such as wheelchairs, hot water temperatures, bedrails and the nurse call system. Accident records were sent to the manager monthly. Those seen were well written and provided factual information about the accident. The manager said that staff analysed accidents to see if they could establish how or why they had occurred and if any action could be taken to prevent further accidents. This information was recorded in one of the files seen on Berens. Staff had access to moving and handling equipment and an individual assessment stating how each resident should be moved was seen in resident’s files. Staff said that information about residents moving and handling needs was provided during handover and could be viewed at any time. Staff received moving and handling training when commencing work in the home and regular updates. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 26 A risk assessment was completed for residents that were using bedrails and training about the use of this equipment was provided for staff. Covers were provided to reduce the risk of injuries. Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 2 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 Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 Requirement The Registered Person must ensure that internal audits of medication are effective in identifying and addressing issues found. The Registered Person must ensure that accurate records are kept for all aspects of medication handling, administration and storage. The Registered Person must take action to control odour and keep all parts of the home fresh. Timescale for action 09/05/07 2. OP9 13 09/05/07 3. OP26 16 09/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The Registered Person should ensure that staff obtain and record adequate information about residents needs during the pre admission assessment. The Registered Person should ensure that care plans: • Are rewritten when residents needs change DS0000006751.V318719.R02.S.doc Version 5.2 Page 29 Abbotsleigh Mews Nursing Home 3. 4. OP15 OP19 Include information about the use of hearing aids, pressure pads and spectacles, where used The Registered Person should ensure that: • Residents are able to choose what they eat • Pureed food is presented in a appetising manner The Registered Person should ensure that further work is undertaken on Berens to improve the environment and maximise resident’s independence. • Abbotsleigh Mews Nursing Home DS0000006751.V318719.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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