Inspection on 07/09/07 for Abbott House Care Home

This inspection was carried out on 7th September 2007.

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

The inspector 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

Abbott House Care Home 29/05/08

Abbott House Care Home 01/06/06

Abbott House Care Home 30/01/06

Abbott House Care Home 11/08/05

Abbott House Care Home 14/01/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Abbott House Care Home Glapthorn Road Oundle Northants PE8 4JA Lead Inspector Kathy Jones Unannounced Inspection 7th September 2007 08:30 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 Abbott House Care Home DS0000060179.V341771.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. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbott House Care Home Address Glapthorn Road Oundle Northants PE8 4JA 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) 01832 272 516 01832 275393 abbott_house@shaw.co.uk www.shaw.co.uk Shaw Healthcare (de Montfort) Ltd Mrs Lynda Taylor Care Home 60 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (60) of places Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - Code OP. Dementia, over the age of 65 - Code DE(E). The maximum number of service users who can be accommodated is 60. 1st June 2006 2. Date of last inspection Brief Description of the Service: At the time of this inspection Abbott House consisted of a new 40 bedded building and the existing unit, which is currently registered to accommodate 20 beds making a total registration of 60 beds. The owners Shaw Healthcare (de Montfort) are carrying out a major redevelopment programme. The aim of the programme was to replace the 32 bed 1960’s home with a purpose built 40 bedded home. Phase 1 of the programme has involved residents at Abbott House transferring to the new building. Some residents from a home in Raunds have transferred to Abbott House while their building is redeveloped. Eventually the plan is to demolish the original building at Abbott House. Abbott House provides twenty four hour care for older people, with some who have a diagnosis of dementia. Abbott House is situated on the outskirts of Oundle in East Northamptonshire, and is within walking distance of the town, which has a variety of small shops, public houses and restaurants/coffee shops. The new building consists of two ten bedded units on the ground floor and two ten bed units on the first floor. All bedrooms are for single occupancy and have en-suite facilities. Each ten bedded unit has a lounge, kitchenette and assisted bathroom and toilet facilities. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 5 The original building currently is able to accommodate up to twenty residents. All bedrooms are single occupancy and the home is divided into small units with a large central dining room. Northamptonshire County Council contract all of the beds in the home and the fees are set at a level agreed as part of that contract. The fee quoted in the guide dated 3 July 2007 was the fee current on 1st April 2006, which was between £444.78 and £465.50. The fee paid by Northamptonshire County Council includes the cost of accommodation, meals, laundry, personal care and activities. The service user guide identifies some of the additional costs that may arise for specific services such as hairdressing. The guide also identifies that there is not a National Health Service dentist in Oundle therefore any dental treatment would need to be arranged privately. The Registered Manager identified that additional costs for residents’ would be personal; items such as toiletries, clothing, newspaper and private chiropody treatment. A copy of the most recent inspection report was available in the hallway of the original building. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls and any complaints received. The report of the last main (key) inspection carried out on the 1st June 2006 and an annual quality assurance self assessment (AQAA) submitted by the Registered Manager were reviewed as part of the inspection planning. The unannounced inspection visit covered the morning and afternoon of a weekday. As the current registration covers the original Abbott House and the new building, time was spent in both buildings. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. A sample of residents’ records was reviewed in both areas. Observations of the homes routines and care provided were made and inspectors spoke with residents’ and staff during the inspection to ascertain their views on the care provided. As some residents’ are less able to express their views due to having a dementia related illness observations were made of their general well being, daily routines and interactions between staff and residents. Surveys were forwarded to a sample of relatives, residents and staff to gather their views on specific aspects of the service and care provided. This was considered to be an important aspect of this inspection and we waited for some responses following the unannounced visit before concluding the inspection. Responses were received from eight residents, six relatives and seven staff. The information from the responses has been incorporated into the inspection findings and a sample of the views included within the report. The management of a sample of residents’ medication was checked. And a sample of staff files reviewed to check the adequacy of the recruitment procedures in safeguarding residents’. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 7 Communal areas and a sample of residents’ bedrooms in both buildings were viewed. Verbal feedback was given to the Registered Manager on the findings of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Bringing together two groups of residents’, two staff teams and two managers has in some cases led to separate systems being operated. Records and systems need to be brought together to assist the Registered Manager in having a full overview of the service. Care plans need to be improved to ensure that they are sufficiently detailed and reflective of residents’ current needs to guide staff in providing consistent and appropriate care. It is also important that risk assessments for the use of equipment such as bed rails have been carried out and that it has been approved by a health professional such as a District Nurse. This is to reduce the risk of injury by making sure that the equipment is safe and appropriate for the individual. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 8 Improvements are needed in the management of medication, making sure that records of all medication held in the home can be easily checked, that residents prescribed medication is always available and has been administered as prescribed. Staffing levels are an area that requires close monitoring to ensure that they are sufficient to meet the needs of the residents at all times. It is important that consideration is given to staffing in all departments, care, domestic and kitchen. 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. Abbott House Care Home DS0000060179.V341771.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 Abbott House Care Home DS0000060179.V341771.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, standard 6 is not applicable as intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Clear information about the home and services is provided to prospective residents’ and their families and there is an admission process, which establishes the homes ability to meet the needs of people admitted to the home prior to admission. However there is no evidence that the same thoroughness has been applied to the temporary transfer of residents’ from Ashfield House. EVIDENCE: Written information is provided in the form of a statement of purpose and a service user guide. These documents provide prospective residents and their families with clear information about the facilities, staff, and the care provided. There is also information about what is included in the fee, which is paid by Northamptonshire County Council as all the beds are contracted to them. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 11 Copies of the statement of purpose and service user guide are available in the reception area of the home. A copy of the most recent inspection report is also available. The statement of purpose and service user guide have recently been updated to include information about the new building and the temporary transfer of residents’ from Ashfield House in Raunds. Discussion with residents, staff and the registered manager identified that prior to moving residents from Ashfield House there had been a series of meetings with residents’ and their families about the move. Meetings and discussions had also taken place with residents’ and their relatives from the original building at Abbott House. Seven of the eight residents who responded in the surveys confirmed that they had received sufficient information about the home before moving in. There is a thorough pre-admission assessment and admission procedure, which establishes if the needs of residents’ admitted to the home, can be met. An assessment of needs is carried out by social services and also by a member of the homes staff prior to admission. However in the case of residents’ admitted under the temporary transfer arrangements there was no evidence of a re-assessment of need prior to admission to Abbott House. A sample check of care plans indicated that they were not fully reflective of residents’ current needs and therefore could not be used as an accurate guide to the level of need creating a risk of their needs not being fully met. Abbott House Care Home DS0000060179.V341771.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. 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. The shortfalls in planning of care, instruction and guidance to staff have the potential to put residents’ at risk of not having their needs including health care needs met. EVIDENCE: Some very positive comments about the care provided were received from relatives, which included “excellent staff and care”. Comments from residents and relatives were, although identifying shortages of staff, positive about the care. One resident stated, “Sometimes there is a lack of staff and this is frustrating but on the whole I am looked after very well” A sample check of residents’ care plans was carried out in the original building and in the dementia unit in the new building. The manager and staff said that they were in the process of reviewing and updating all residents care files and transferring to a new consistent and simpler care planning format. It is Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 13 anticipated that this will help staff in accessing more easily important information about the care to be provided to individuals. A staff member identified that although important information is passed verbally to staff there is not always time for them to familiarise themselves with updates to care plans. Care plans are important documents which help to ensure staff have the right information to meet residents needs. The annual quality assurance self assessment completed by the Registered Manager also identifies the intention to involve families more in the production of a needs led care plan. Review of a sample of residents’ care files confirmed that improvements are needed to the care plans and risk assessments. This is to ensure that they are sufficiently detailed and reflective of residents’ current needs to guide staff in providing consistent and appropriate care. Review of the care records for one resident relating to the risk of pressure ulcers identified that the resident had been identified as being at high risk of developing pressure ulcers. A risk assessment which had been reviewed recently, only contained general statements such as “staff to be aware of the tissue viability and pressure relief policy” rather than specific information about the individual and the areas of risk. There was no care plan to guide staff in the actions that they should take to reduce the risk. A monthly summary completed on 20 August 2007 for the resident referred to above did identify a red area to the skin but stated that there were no broken areas. However records show that three days after the monthly summary the District Nurse visited, as the area was very sore, red and bleeding. Advice has been given that there should be care plans in place for all residents’ identified as being at risk of pressure ulcers, which give staff clear instructions for staff to follow based on advice from the District Nurse. No care plan was in place for a resident who had lost weight and was identified as having a poor appetite. There was evidence that the General Practitioner had been contacted and a food supplement had been prescribed. There was also evidence from conversations heard that staff including the cook were aware of the need to consider suitable alternatives to the menu that might tempt the resident’s appetite. Daily records had been put in place to monitor the amount of food and fluid that the resident had taken. However there was evidence that some staff need more guidance on the use of these records as it was discovered that some entries related to the amount offered rather than the amount taken giving an inaccurate picture. Information received from a sample of staff in the surveys confirms that they are aware of residents care plans, however due to staff shortages they are finding it difficult to find time to check residents’ care plans for any changes to their needs. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 14 Records of General Practitioner and other health care professional visits were seen on the files checked. The General Practitioner from the local surgery visits the home weekly and a list of residents who wish/need medical advice is compiled. However General Practitioner visits are requested if more urgent medical attention is required. Conversations and observations during the inspection identified that care is taken to keep relatives informed of changes in a residents’ health. Staff advised that bed rails were in place on a residents’ bed due to concerns about the risk of falls from bed. Staff thought that a risk assessment had been carried out to check that the rails were safe to use for that particular resident and suitable for the bed. However a risk assessment could not be found to confirm this. There was also no evidence of their use being authorised by the District Nurse, other appropriate health professional or agreed with family. The Registered Manager confirmed that this would be addressed urgently. A sample check of residents’ medication was carried out in the original building. This identified some errors in the booking in of medication. Advice was also given to record any medication carried forward to the next cycle as without this information it is difficult to carry out an accurate audit of medication. This is important to ensure that any discrepancies and shortfalls in medication can be quickly identified and addressed. The pharmacist who supplies residents’ medication has recently carried out an audit of the management of medication and identified that one resident had no stock of a prescribed calcium tablet. Records showed that at the time of the inspection the medication had not been administered to the resident for one week. Confirmation was given that this would be investigated and arrangements made to ensure that residents’ medication was available. A monthly summary completed for a resident stated that Cavillon cream should be applied. The medication administration record shows that other creams were prescribed for the resident but there was no evidence of Cavillon cream being prescribed or any record of the other creams being applied on a regular basis. Observations during the inspection identified that staff spoke to and treated residents’ with respect. A relative commented “treat the clients as real people – with respect not as ‘naughty Children’”. Staff were generally mindful of protecting residents’ dignity, however one incident was observed where an individual staff member had not closed a bedroom door and did not protect a resident’s dignity. This matter was taken seriously by senior staff and the Registered Manager who confirmed that it would be made clear to staff that this was not acceptable. Abbott House Care Home DS0000060179.V341771.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): 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. Visitors are encouraged and welcomed into the home, residents’ are happy with the quality of food provided and there is a programme of activities. EVIDENCE: The service user guide provides good information about the lifestyle at Abbott House and an activity programme is displayed on the notice board. Records are also kept of the activities that individuals have taken part in. Residents confirmed in the surveys that there are activities that they can take part in if they wish. In house activities include sing a long sessions and card games and quizzes, help with mental stimulation. There are also social events such as coffee mornings, and a hymn and a sherry morning. A resident said that they also make use of the garden when the weather is good. The service user guide states that there is a church service held in the home once a week and that Holy Communion is celebrated monthly. Records Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 16 reviewed for one resident confirmed that they had appreciated joining in with the church services. While residents’ records confirmed that they had taken part in activities, discussion with residents’ and staff indicated that these had of late not been as frequent as they were. There are two activity organisers who plan and organise the activities. On the day of the inspection the activity organisers were working as carers to help provide and support residents’ care. However discussion with staff confirmed that they continued to be mindful of the need for residents’ to have some activity. Staff were observed to be chatting to residents’ and some residents’ appeared to be enjoying a video of the titanic. The annual quality assurance self assessment identifies that work is planned over the next twelve months to look at new ideas for activities. The inspector did not have the opportunity of speaking with visitors during the inspection, however a resident confirmed that the visiting arrangements are flexible. Residents’ spoken with were able to confirm that they are given choices about where they spend their day, and their choice to stay in their own rooms rather than in the shared lounges is respected. The staff team consists of a mix of staff from Abbott House and some from Ashfield House. Discussion with staff identified that each member of staff has a good understanding of the residents that they were working with in their previous homes and are beginning to find out about the needs and preferences of the other residents. Advice was given to ensure that any particular routines or observed preferences particularly for residents’ with dementia are recorded as part of the care plan to ensure that all staff and any new staff are aware. Dining tables were appropriately laid for breakfast with clean cloths and cutlery and tea was brought to the table in teapots providing residents’ with some independence and choice. Residents’ said they have a choice of what they want for breakfast. The cook was observed to visit each resident at the breakfast table and offer them a choice for their lunch time meal. Residents spoken with were satisfied with the meals provided and discussion with the cook confirmed that she was aware of any specific dietary needs. Staff were observed to provide residents’ with any necessary assistance with their lunch time meal. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures for dealing with concerns and complaints, which residents and relatives are made aware of and staff are aware of their responsibilities for protecting the people in their care. EVIDENCE: Discussion with residents’ indicated that they felt able to raise any concerns that they might have. There is a complaint procedure, which is detailed within the service user guide. The procedure encourages people to raise any concerns with staff or the Manager. It also provides contact details for the Regional Manager and also Head Office for use in the event that someone is not happy with how their concerns have been dealt with by the Manager. Surveys from residents confirm that they know how to raise concerns and one confirmed that they have a copy of the complaints procedure in their “important papers box” The Commission for Social Care Inspection has received two complaints about the service since the last inspection. The complaints were referred to the provider for investigation under their complaint procedures. Records confirm that the complaints were investigated and no evidence found to support the Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 18 concerns. One of the complaints dated back to June 2006 and the other was an anonymous complaint in March 2007 about staffing levels. Review of the complaint record held in the home identified that they had also received a complaint from a relative at the end of August 2007 about staffing levels and some care issues. The paperwork had not been completed regarding the outcome, as it was so recent, however the actions were discussed. The Registered Manager confirmed that the issues had been looked into, and the action taken discussed with all relatives at a relatives meeting the night before the inspection. This demonstrates a willingness to acknowledge and act on any identified shortfalls. Staff at Abbott House notified the Commission for Social Care Inspection (CSCI) that they have reported two thefts from residents’ to the police recently. There were some records relating to the incidents however there was no evidence within the documentation that the incidents have been reported to safeguarding adults. The Registered Manager advised that she was on holiday at the time of the incidents, however has confirmed that she will check that appropriate actions have been taken to protect residents’ including making a referral to safeguarding adults and inform CSCI of the outcome. A requirement has been made in relation to record keeping. Discussion with staff confirmed that they are aware of their responsibilities for safeguarding the residents’ in their care. Responses in surveys from staff confirm that they are aware of what to do if a complaint is received. Training records show that the majority of staff received protection of vulnerable adults training in March or July 2007, which helps staff to understand their role and protect residents’. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. When complete the programme of improvements will provide all residents with an excellent standard of accommodation. At present some residents’ are located in the new building, however all residents have clean and comfortable accommodation which is appropriately maintained. EVIDENCE: The Inspector visited parts of the old and new buildings during the inspection. Although the old building does not meet current expectations in terms of space, it was found to be clean and comfortable and adequately maintained. Records were in place to confirm that equipment such as the passenger lift are serviced regularly. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 20 The new building has been built to a very high standard and is spacious, light and airy. The building has been designed to provide small group living. Each of the two floors consists of two ten bedded units which are linked. Each unit has an assisted bathroom, which is spacious and equipped to meet the dependency needs of residents. There is also an open plan lounge, dining room and kitchenette in each unit. Bedrooms in the new building are all single, have en-suite facilities and are of a good size. They are comfortably furnished with good quality furnishings and residents’ have obviously been encouraged to bring in personal items to individualise their rooms and provide a familiar environment. Abbott House is fully accessible to people with physical disabilities and specialist equipment and adaptations have been fitted in the new building. All areas of the home were clean and smelled fresh. The annual quality assurance self assessment identifies that guidance from the Department of Health has been used to assess the management of infection control. There was also evidence of staff training in infection control. There was however one incident witnessed by the Inspector, which identified poor staff practice in relation to infection control, which will be addressed by the Registered Manager. Abbott House Care Home DS0000060179.V341771.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. 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. Staff receive training to provide them with the necessary knowledge and skills to meet the needs of residents. However staffing levels require close monitoring to ensure they are maintained at a level, which provides adequate care and protection for residents. EVIDENCE: Discussion with residents and staff identified that since the transfer of residents’ from Ashfield House and relocation of residents’ in the new building that there have been some staffing difficulties. Staff from Ashfield House and the original Abbott House have come together as one staff team and are working across the old and new buildings with some residents’ that they know and others who are new to them. Some residents’ said that they had to wait longer for assistance and staff spoken with during the inspection acknowledged that there have been times when it has been difficult to meet residents’ needs, particularly as there are several residents’ who have been identified as having a high level of needs. Surveys received from a sample of staff supported concerns raised during inspection and identified that many staff are concerned about staffing shortfalls Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 22 in all departments and the impact on staff morale and resident care. However some staff spoken with and some responses in the surveys indicated that some felt that the situation was improving. Comments received from relatives and residents were positive about the staff team. Several acknowledged the difficulties and pressure that staff were under with the transfer of residents to the new building and from Ashfield House. Comments included “extremely pleased with their understanding of my mother and the care they give her” and “The staff are excellent at their job”. Discussion with staff identified that the majority of staff are committed to minimising the effect of the changes to residents and have worked hard, sometimes in different roles to meet residents’ needs. The Registered Manager confirmed that where it has not been possible to cover staffing shortfalls with existing staff then agency staff are used. Staff said that advertisements for staff were being placed in the local area and some interviews were being held on the day of inspection. Discussion with staff, responses in surveys and review of the training matrix confirmed that there is an ongoing training programme to provide staff with the necessary knowledge and skills to meet residents’ needs. Information received in the annual quality assurance assessment identifies that seventeen of the fifty one permanent care staff hold a National Vocational Qualification (NVQ) at level 2 or above and a further seven are working towards it. This qualification helps staff to understand the needs of older people and current care practices. Information about staff training in dementia care was provided as part of the application to increase the registered numbers. The registered manager confirmed that the dementia care training is ongoing. This is important in ensuring that the needs of people are met. A sample check of staff records was reviewed to check the adequacy of the recruitment process in protecting residents’. Applications with a full employment history were held on staff files. The Registered Manager advised that the organisation now operate a system where documents such as references and evidence of criminal record bureau clearances are scanned at the head office and stored electronically. Review of the electronic records for three members of staff confirmed that criminal record bureau clearances had been obtained prior to staff starting work. In two cases there was no evidence of the references and in the third there was only one reference. It was therefore not possible to evidence at the time of inspection that these references had been obtained. However seven out of seven staff that completed surveys confirmed that their employer had carried out checks such as a criminal record bureau check and references before they started work. The evidence indicates that this may be a record Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 23 keeping issue rather than poor recruitment practices and a requirement has been made in relation to record keeping. Abbott House Care Home DS0000060179.V341771.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, 32, 33, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced manager who promotes and safeguards the health, safety and welfare of residents’ manages the home. However records and systems for both buildings need to be combined to ensure the Registered Manager is able to have full oversight of the care provided. EVIDENCE: The Registered Manager meets the standards for Registered Managers as set out, and has completed the National Vocational Qualification level 4 in management, and the Registered Managers Award. The Registered Manager has managed Abbott House for several years and now has overall responsibility for what is currently a 60 bedded unit. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 25 Staff spoken with had confidence in the Registered Manager, they confirmed that any concerns that they had would be listened to and acted on. For example the concerns that they had about staffing levels had been raised with the Registered Manager and staff said that they felt confident that she was working hard to address the problems. At the time of the inspection there were indications of separate systems being operated in the existing part of the building and the new. Some of the records from Ashfield House were in place in the existing building. Advice was given to sort and archive all records brought from Ashfield House such as maintenance records, which relate specifically to those premises to avoid any confusion. Advice was also given to ensure that information relating to events since the move to Abbott House such as complaints are added to the Abbott House records. This is to ensure that the Registered Manager has a complete overview of the registered service and is able to act accordingly in respect of the welfare of residents’. As detailed in the complaints and staffing sections of this report some records were incomplete making it difficult to see all the actions taken in respect of a safeguarding issues and staff recruitment. Shaw Healthcare have various quality assurance tools and part of this is a thorough annual quality assurance audit called “Components of Good Care”. The audit is carried out by the quality assurance. The last one was in October 2006, therefore the Registered Manager is anticipating another one soon. The findings of the last audit were very positive. The area manager also carries out unannounced visits at least monthly to assess and report to the organisation on the conduct of the home and the quality of care provided. No health and safety concerns were identified during this inspection visit. Staff are provided with training in safe working practices such as movement and handling, fire safety and food hygiene. A fire drill was carried out during the inspection and staff were observed to be aware of their responsibilities and respond appropriately. Abbott House Care Home DS0000060179.V341771.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 3 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 2 3 Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 (1) (a). Requirement Timescale for action 15/11/07 2. OP7 12 (1) (a & b), 15. 3. OP8 12 (1) (a) 4. OP8 13 (4) (c) A thorough assessment of a prospective resident’s needs must be carried out prior to admission for everyone, including people admitted temporarily. This is to ensure that their needs can be met. Care plans and risk assessments 15/12/07 must be reflective of residents’ current care, physical and mental health needs and be sufficiently detailed to guide staff in providing appropriate and consistent care. Arrangements must be in place 15/11/07 to ensure that residents’ health care needs are effectively monitored including where appropriate the accurate completion of food and fluid charts. Prior to bed rails being used, a 15/11/07 thorough assessment must be carried out to ensure that the equipment is safe for the resident and suitable for the bed. Authorisation must also be obtained from an appropriate health professional. DS0000060179.V341771.R01.S.doc Version 5.2 Abbott House Care Home Page 28 5. OP8 13 (2) 6. OP8 13 (2) 7. OP27 18 (1) (a) 8. OP37 17 (1, 2, 3) Quantities of medication carried forward from the previous month must be recorded as part of an audit trail. This is to assist in monitoring safe practice in relation to the management of residents’ medication. Arrangements must be in place to ensure that residents’ prescribed medication is available and administered as prescribed. This must include prescribed creams. Staffing levels for care and support staff must be closely monitored to ensure that they are maintained at adequate levels to meet residents’ needs. All required records including staff and complaints records must be kept up to date and available for inspection. 15/11/07 15/11/07 15/11/07 15/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP37 Good Practice Recommendations Records relating to Ashfield House premises should be separated to avoid any confusion. Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Abbott House Care Home DS0000060179.V341771.R01.S.doc Version 5.2 Page 30 - 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. 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