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Inspection on 26/05/10 for Abbottswood Lodge.

Also see our care home review for Abbottswood Lodge. for more information

This inspection was carried out on 26th May 2010.

CQC found this care home to be providing an Good service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Manager and deputy manager were helpful during our visit and provided us with information that we asked for. At the time of our last visit care staff were working in the kitchen on the chefs days off. The member of staff doing this was not always replaced as part of the care team which meant that there were not enough care staff on duty. However, since our last visit a member of staff has been recruited to cover these duties and we were told that care staff are no longer responsible for this. At the time of our last visit we found that the certificates for the servicing of the fire safety equipment had recently elapsed. The deputy manager immediately arranged for this to be carried out and we could see the records relating to this. However, the emergency lighting was omitted from this service and still remains to be done. The care plans have started to be archived so that it is easier for staff to find information. They are now kept in the staff room so that staff have easier access to them. We looked at the medication system. We could see that records are kept of medication received at the Home and that administered to residents. We checked one residents medication against the records and there were no problems identified.

What the care home could do better:

We continue to have concerns about the ability of the Home to meet the needs of two of the residents and about the decision that was made to admit them to the Home initially. The residents have specific needs that are very different to those of the majority of the other residents living at the Home. Since our last visit action has started to be taken to review this situation. During our last visit we noted that the care plans were not detailed enough to provide clear guidance to staff about how to meet residents needs. Risk assessments are eithernot present or are inadequate. During this visit we looked at two care plans and can see that some additional information has been added to them. However, they remain inadequate as they still do not contain detailed information about how to meet residents needs, nor adequate risk assessments. The daily notes are brief and mainly state `....is fine`. They contain little information about how the residents spends their time, how they are physically and emotionally or about any activities they may have taken part in. During our last visit we noted that staff are not receiving adequate training to enable them to meet the needs of the residents. We were unable to see the updated training matrix at that time but have since been provided with a copy of this. This shows that staff have received basic mandatory training but no training about issues specific to individual residents needs, apart from one short workshop about one specific issue. We also have concerns about the quality of the training provided. We were told that, apart from Moving and Handling, First Aid and Medication, all training is provided through the use of DVDs and questionnaires. The questionnaires are marked by the Manager who is not a qualified trainer. This form of training is not adequate to ensure that staff have a good understanding. At the time of our last visit we noted that the Safeguarding procedure was out of date and inaccurate. During this visit we asked to see the updated procedure. The old procedure has been removed but not been replaced. The Home has a folder of information about the procedure in place for making referrals to the local authority safeguarding team and other information about abuse. However, there is no safeguarding procedure for the Home. We also looked at the Whistleblowing procedure which is not sufficient to provide clear information to staff about this issue. During the last visit we noted that the staffing levels are not adequate. The staffing remains as three or four staff on duty between 8am - 5pm and four staff on duty from 5pm - 10pm. During the week between 4 - 6 residents attend formal day services away from the Home. In addition to the care staff there are also domestic and catering staff. Whilst there is now a chef on duty each day the care staff are still responsible for preparing tea and clearing up afterwards. During our last visit, and during this visit, we were told that the staffing levels are adequate to meet the residents personal and physical care needs but not sufficient to enable them to take part in meaningful activities. The Home includes a large main house with a large, separate bungalow next door. There is no call bell system and so staff may, on occasions, find it difficult to locate other staff for assistance. It also means that residents are not able to call for assistance when they need it. We made a recommendation that a risk assessment be carried out. We were sent a copy of the risk assessment that had been carried out in November 2009 but this was not adequate and we have asked for an updated risk assessment. During this visit we asked for this but it has not been done yet. At the time of the Key Inspection a requirement was made to ensure that the cold storage of medication meets with current guidelines. During this visit we saw that eye drops, and another medication already drawn up in a syringe with needles, are being kept in the kitchen fridge. Neither the kitchen, or the fridge, is locked. There is no riskassessment for this. The Manager said that they are speaking to the pharmacy about obtaining a suitable medication fridge.

Random inspection report Care homes for adults (18-65 years) Name: Address: Abbottswood Lodge. Church Lane Swanton Abbott Norwich Norfolk NR10 5DY two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lella Hudson Date: 2 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: Abbottswood Lodge. Church Lane Swanton Abbott Norwich Norfolk NR10 5DY 01692538455 01692538725 abbottswoodlodge@abc-care-solutions.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Abbottswood Lodge Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 22 The maximum number of service users who can be accommodated is: 22 The registered person 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 to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Abbottswood Lodge is a period residence that has been adapted and extended to provide residential accommodation for up to 22 adults with learning difficulties. The property is in a very rural location outside the small village of Swanton Abbott, south Care Homes for Adults (18-65 years) Page 2 of 11 1 4 0 4 2 0 1 0 Brief description of the care home of North Walsham. The majority of places are in single rooms and nine of the rooms are located in a self contained unit in the extension. This has its own lounge and kitchenette. People accommodated within the main house generally have higher care needs. The home in addition has spacious communal accommodation and an activities room. The premises stand in extensive grounds overlooking farmland. Fees generally range from around £450 and are dependent on individual needs and support assessed at placement. A statement of purpose and service user guide is kept in the main office and is available on request. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: The Home had a Key Inspection in June 2008 and at that time the quality rating was assessed as being GOOD. Following incidents notified to the Commission we carried out an unannounced Random Inspection in April 2010. Requirements for improvements were made at that time. This report contains information gathered about the Home recently, including during an unannounced visit to the Home on the 26th May 2010. During this visit the Manager and deputy manager were both present. We spoke to them and looked at a selection of records. We also looked at the medication system. There were 20 residents living at the Home at the time of our visit. We did not check all of the requirements during this visit as some dates have not yet expired and so they are repeated at the end of the report. However, we did check on progress towards meeting those requirements and have commented on this. What the care home does well: What they could do better: We continue to have concerns about the ability of the Home to meet the needs of two of the residents and about the decision that was made to admit them to the Home initially. The residents have specific needs that are very different to those of the majority of the other residents living at the Home. Since our last visit action has started to be taken to review this situation. During our last visit we noted that the care plans were not detailed enough to provide clear guidance to staff about how to meet residents needs. Risk assessments are either Care Homes for Adults (18-65 years) Page 4 of 11 not present or are inadequate. During this visit we looked at two care plans and can see that some additional information has been added to them. However, they remain inadequate as they still do not contain detailed information about how to meet residents needs, nor adequate risk assessments. The daily notes are brief and mainly state ....is fine. They contain little information about how the residents spends their time, how they are physically and emotionally or about any activities they may have taken part in. During our last visit we noted that staff are not receiving adequate training to enable them to meet the needs of the residents. We were unable to see the updated training matrix at that time but have since been provided with a copy of this. This shows that staff have received basic mandatory training but no training about issues specific to individual residents needs, apart from one short workshop about one specific issue. We also have concerns about the quality of the training provided. We were told that, apart from Moving and Handling, First Aid and Medication, all training is provided through the use of DVDs and questionnaires. The questionnaires are marked by the Manager who is not a qualified trainer. This form of training is not adequate to ensure that staff have a good understanding. At the time of our last visit we noted that the Safeguarding procedure was out of date and inaccurate. During this visit we asked to see the updated procedure. The old procedure has been removed but not been replaced. The Home has a folder of information about the procedure in place for making referrals to the local authority safeguarding team and other information about abuse. However, there is no safeguarding procedure for the Home. We also looked at the Whistleblowing procedure which is not sufficient to provide clear information to staff about this issue. During the last visit we noted that the staffing levels are not adequate. The staffing remains as three or four staff on duty between 8am - 5pm and four staff on duty from 5pm - 10pm. During the week between 4 - 6 residents attend formal day services away from the Home. In addition to the care staff there are also domestic and catering staff. Whilst there is now a chef on duty each day the care staff are still responsible for preparing tea and clearing up afterwards. During our last visit, and during this visit, we were told that the staffing levels are adequate to meet the residents personal and physical care needs but not sufficient to enable them to take part in meaningful activities. The Home includes a large main house with a large, separate bungalow next door. There is no call bell system and so staff may, on occasions, find it difficult to locate other staff for assistance. It also means that residents are not able to call for assistance when they need it. We made a recommendation that a risk assessment be carried out. We were sent a copy of the risk assessment that had been carried out in November 2009 but this was not adequate and we have asked for an updated risk assessment. During this visit we asked for this but it has not been done yet. At the time of the Key Inspection a requirement was made to ensure that the cold storage of medication meets with current guidelines. During this visit we saw that eye drops, and another medication already drawn up in a syringe with needles, are being kept in the kitchen fridge. Neither the kitchen, or the fridge, is locked. There is no risk Care Homes for Adults (18-65 years) Page 5 of 11 assessment for this. The Manager said that they are speaking to the pharmacy about obtaining a suitable medication fridge. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 5 That each resident has a copy of the statement of purpose that includes the complaints procedure, in a format that suits the individual. 28/11/2008 2 3 12 It is required that the Home only admits residents whose needs can be met there To ensure that residents needs are met 16/04/2010 3 6 15 It is required that the care plans contain detailed information about how residents needs should be met To ensure that staff have clear guidance about how to meet residents needs 31/05/2010 4 9 13 It is required that risks are 14/05/2010 identified and that appropriate assessments are carried out. To ensure that risks to residents and staff are minimised 5 14 12 That every resident has a regular opportunity for 28/11/2008 Care Homes for Adults (18-65 years) Page 7 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action outings or activities outside the home, to ensure their needs are met. 6 20 13 To ensure that cold storage of medicine meets with set guidelines. 29/09/2008 7 22 22 That there is a record of any 29/09/2008 complaint with identified actions, timescales and outcomes, to demonstrate that matters have been dealt with appropriately. 8 23 13 It is required that all staff receive appropriate Safeguarding Adults training To provide protection to the residents from abuse 31/05/2010 9 23 13 It is required that the Safeguarding adults procedure is reviewed and updated To ensure that staff have clear guidance to follow if needed 23/04/2010 10 33 18 It is required that staffing levels are adequate to meet the needs of residents To ensure that residents needs are met 30/04/2010 Care Homes for Adults (18-65 years) Page 8 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 11 35 18 It is required that staff receive appropriate training to carry out their roles effectively To ensure that staff have the appropriate skills to meet the needs of the residents 30/06/2010 12 42 23 To ensure that all fire safety 16/04/2010 equipment is serviced adequately and to confirm to the Commission when this has been done To protect the safety of the residents and staff in the event of a fire Care Homes for Adults (18-65 years) Page 9 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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