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Inspection on 04/11/08 for Abercarn Residential Home

Also see our care home review for Abercarn Residential Home for more information

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Adequate service.

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.

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abercarn Residential Home 56 High Street Pensnett Dudley West Midlands DY5 4RS     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tina Smith     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 43 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 43 Information about the care home Name of care home: Address: Abercarn Residential Home 56 High Street Pensnett Dudley West Midlands DY5 4RS 01384480059 01384480059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cotdean Nursing Homes Limited care home 32 Number of places (if applicable): Under 65 Over 65 3 20 0 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 1 0 1 Abercarn is a located in the heart of Pensnett on a main road between Kingswinford and Dudley, served by a bus route. There is car parking at the front and side of the property. The home provides accommodation for a maximum of 32 people on two floors, accessed by a lift. On the ground floor, there is a communal lounge, and the office is in the corner of the dining room. In the enclosed garden there is a covered area for people who smoke and a laundry building. Bedrooms are on the ground and first floor, have washbasins, and a few of these are double rooms. There are communal toilets located throughout the home and near communal areas, but these cannot accommodate a wheelchair and hoist. People needing this equipment may not feel able Care Homes for Older People Page 4 of 43 Brief description of the care home to use communal areas except for short periods. There are two assisted bathrooms; a bath on the ground floor and a shower on the first. At the time of our visit there was a temporary acting manager two days a week, supported by the Cotdean Director of Nursing, and a new manager was being recruited. Enquiries need to be made from the care home about the fee range, as the information published in the service user guide is out of date and only applied up to March 2008. Care Homes for Older People Page 5 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors visited separately over 7 days; one is a regulation inspector, the other a specialist pharmacy inspector. The home was not informed that we would be visiting. We examined records, talked to people, staff, visitors and other professionals. We observed care practice, a meal and medication was inspected with management and care staff. We discussed our findings with the Cotdean Director of Nursing on both days. Prior to our visit the home supplied information to us in the form of its Annual Quality Assurance Assessment (AQAA). The last inspection of this service was completed on 15/11/07. Information from the AQAA, previous inspection and from other sources was also used when forming judgements on the quality of service provided at the home. We Care Homes for Older People Page 6 of 43 received 22 out of 31 surveys sent to people, relatives, staff and professionals. During our visit we case-tracked 3 people that staff in charge of the home helped us to choose: the newest admission, the person with the most complex care and a person with a specific health condition. We closely examined their records, equipment and rooms, spoke with them and their staff. We also sampled other records about several people, staff and the running of the home. We would like to thank people in the home and staff for their assistance. There were 21 requirements from previous inspections. As a result of our visit we found that two of these had been met in full. Others were were replaced. We made new requirements and recommendations as a result of our visits, 3 of which needed urgent action to ensure people were safe. There are now in total, 21 requirements and 20 recommendations. Further action is being considered under our enforcement policy. What the care home does well: What has improved since the last inspection? There are regular meetings with people using the service and staff about the running of the home, as well as surveys. People were consulted about the menu choices and activities, and changes were made. Movement to music is popular and provides exercise. Responsible action was taken to conclude a previous adult protection matter and safeguard other people in the care sector. Two requirements made at a previous inspection were met, and others were partly met. A shower was installed so people have more bathing choice, and people now have a lockable facility in their rooms. Reception, the dining area and flooring were refurbished, and an outdoor enclosed area was created in the garden for people who smoke. The home is now smoke free. The laundry room was completely refurbished Care Homes for Older People Page 8 of 43 and decorated and there is a colour-coded mop system, making use of best practice guidance. 70 of staff have or are working towards NVQ 2 qualifications, which is above national minimum standards. All staff have been trained in food safety and infection control, and some staff have had dementia awareness training. What they could do better: Public information needs to be updated and accessible so that the fee range, legal requirements and outside agency contact details can be used by people to make informed decisions about the home, or express concerns. Care planning, record keeping and the medication system need to improve for peoples health and wellbeing. Care plans reviews and quality audits are not evaluating the effectiveness of plans. We cannot confirm that people have food in keeping with their dietary needs, medication as their doctor intends, that is stored safely, or that competent staff administer and manage the medication. Medication was missing; record keeping, storage and management oversight about this is poor, including peoples own selfadministration. Urgent requirements were made for peoples health and safety about medication, special diets and monitoring malnutrition. There were no behaviour plans and we did not always see lawful consent or best interest decisions about physical and chemical restraint used to manage falls risk and behaviour. We cannot be sure people participate in agreeing their care plans; some wanted to be more independent or needed physiotherapy to regain mobility. There is a person isolated in their room, who does not have equal opportunity to use communal areas because toilets cannot accommodate a wheelchair and hoist. There is a lack of respect for peoples property, which is not always returned after laundering. All rooms should have door locks so that everyone can choose when they want privacy; currently people need to ask for locks. People and staff needed equipment we were told was on the premises but could not be found. There are some matters for consultation with people about their dignity and personal hygiene. Although people told us the home is fresh and clean, we found some infection control, hygiene and fire safety risks, and there are unmet council requirements about food safety. Repairs are not always timely. Shower water temperature has not been tested to prevent people being scalded. Health and safety checks are made but are not thorough. We could not confirm that staff are trained to their roles, to handle equipment and medication, provide first aid and to understand peoples conditions. Supervision and appraisal of staff performance does not meet national minimum standards and a previous requirement. Policies and procedures requested were not available, so these are also not accessible Care Homes for Older People Page 9 of 43 for staff and may not be up to date. The staff team have functioned without a manager in post for long periods. Interim management does not have sufficient supernumerary time and delegates management tasks to others without managerial oversight. The only audit made available to us was dated July 08 when there was a manager in post. We found there is a lack of leadership and accountability for running the home in peoples best interests, and ensuring systems are known about and used. Standards are slipping; the home has not registered a fit manager with CSCI or progressed regulator requirements to improve service safety and quality, and teamwork needs direction. We are told that a new manager will be appointed on the same supernumerary hours as at present. 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 43 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is not fully accurate or accessible but people can try the home to make an informed decision about staying there. Everyone has an assessment by trained staff before admission takes place, so they know that their needs can be met. Evidence: People told us they had information to make a decision about the home: I was given a lot, Lots of information from the manager. We found that there is helpful written information available about Cotdean Homes, but is not up to date about Abercarn, for instance regarding fees and management. People considering Abercarn will need to enquire carefully from the home to make an informed decision about its suitability. The service user guide, dated October 2007, is provided to everyone and we saw it was in peoples rooms. The latest CSCI Report and the homes statement of purpose is Care Homes for Older People Page 12 of 43 Evidence: available on request. We found two copies of the undated statement of purpose on display in the outer vestibule and in reception. One was incomplete, and the other was inaccessible behind a settee; the light reflected on it so it could not be easily read. We found information in both documents to be inconsistent and insufficient to help people with their decision. The service user guide provides information about all Cotdean homes and units, however there is no detailed information about Abercarns facilities and furnishings, as is legally required. There have been two acting managers since the person listed as manager left the post. The fees applied up to March 2008. There is helpful information explaining council funding, encouraging visits to try the home, making complaints and fire safety precautions, etc. In records we saw there are clear terms and conditions signed with people or their representatives. Most people also have social services contracts, but there are also people funding their own care in the home. Care records did not record whether people visited the home before admission. One person we spoke to was admitted from hospital and was unable to visit, so staff came to the hospital. One out of 3 records seen had a written letter from the home confirming that their needs could be met. Everyone case-tracked had a pre-admission assessment by trained staff, a care plan and trial period which was reviewed. This means that people can try the home and decide whether it is suitable. The homes service user guide says that ...short stay care is not limited in any way in comparison to long stay care.... We found that there were assessments of peoples needs and risks, but people having short stays had less thorough assessments. Other assessments needed more detail so that peoles needs and risks could be comprehensively met. At the time of our visit there were 23 people in residence and 4 vacancies. People in double rooms are considered to be occupying a single room, and we were told by the interim management that people would not share their room without their consent. Care Homes for Older People Page 13 of 43 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are set out in a plan that includes their preferences; some need updating, detailed instruction for staff, and lawful consent. People are treated with respect, but the care planning and medication systems need improvement and oversight to ensure peoples needs are fully recognised and safely met. Evidence: People are treated with respect and have privacy, but we had concerns for peoples health which we fed back to management and left 3 urgent requirements. We extended the inspection and included an unannounced visit one week later by a CSCI Pharmacy Inspector to examine the medication system and allied care records. We found requirements made at a previous inspection not met. This section of the report summarises the findings of the two inspectors. Everyone has an assessment of needs by trained staff. People have screening for nutrition, pressure sore and falls risks. There is a good admission format so that peoples preferences, likes, dislikes and religious needs are considered . This is used to Care Homes for Older People Page 14 of 43 Evidence: form care plans, which are usually reviewed monthly by staff. Peoples preferences change and we gained a mixed picture of how these are known about, respected, and care plans updated (see Daily Life). We did not see individual choices recorded about frequency of bathing and we saw unexplained gaps in bathing records for two people assessed to be at risk of pressure sores, so an outstanding requirement was not met. One person told us they did not have a bath for sometime while staff sorted the hoist; their records show that they now only bathe fortnightly with bed baths inbetween. People refuse bathing, which is respected. The home encourages independence and peoples participation in personal care. For instance, continence is prompted and care plans indicate whether people can choose their own clothing, use a flannel to wash their face and hands. One person said they wanted to be more independent but this had not been reviewed with them and they had to wait for the right sized commode. Health specialists are generally involved with people in the home. However two people lost mobility during the past year; neither have been referred to physiotherapy to aid their recovery. One person is fearful of mobilising after an unexplained fracture; the other gained weight, which can affect regaining their mobility and independence. There are no plans about this. Staff did not always understand the conditions medication is used to treat, and there was no written guidance, e.g. on symptoms, side effects and contra-indications that staff need to watch for and know when to seek specialist advice. We found several examples of insufficient staff guidance, monitoring of peoples health conditions and wellbeing and evaluation of the effectiveness of their plan. One person manages stoma care themselves but staff need to prompt this without written guidelines, and the stoma site became inflamed twice. We made management aware that this person needs further health advice. Seven people in the home have diabetes, most controlled by diet and tablets, and other people have special dietary needs. Three people case-tracked had diabetes and nutritional risks identified, two were losing weight, but only one had a diabetes care plan. We did not see how long gaps between meals, for instance, are being avoided to manage blood sugar levels and associated risks, and at least annual health checks. Chiropody and eye and nail care is in place. One person did not have a baseline weight recorded on admission, and their weight records sometimes used imperial or metric measures, making it hard to assess gain or loss. There were no weight records for April or July 08. Management said that weighing scales are shared with another home and did not fit in their vehicle, which was changed. Care Homes for Older People Page 15 of 43 Evidence: People have risks that are linked, such as pressure sores and malnutrition but we saw no plans to monitor and evaluate food and fluid intake or to fortify food to increase calorie content. We found that care and catering staff did not communicate or have clear roles to ensure nutritional needs are met and we saw people with diabetes put at unnecessary risk. This is discussed further in other sections of this report. We were told that there is no one in the home with a behaviour plan. One persons records note periods of aggression. Risks to others, self harm or property and triggers are not assessed and there is no care plan about this. We found other peoples behaviour being managed by covert liquid medication in the home. There were no assessments about whether people can make their own decisions about physical or chemical restraint in accordance with the Mental Capacity Act code of practice, such as bedrails or covert medication to minimise risk of falls from bed and to manage behaviour. Not all had written consent or recorded best interest decisions by appropriate clinicians, confirming this was the least restrictive option. The homes medication policies and procedures were not available to us on both of our visits so we could see how people are protected. Staff need ready access to these. We found several concerns about the safety of Abercarns medication system and management oversight of this. There are outstanding requirements from the last inspection that are unmet, new concerns and lack of timely action to address risks we fedback to management. On two visits we found perished and out of date medication and homely remedies, storage that does not follow manufacturer instructions so that medication is safe for use and doesnt make people ill. The storage cabinet for controlled drugs did not comply with regulations; this was amended during our second visit. Medication is not always checked when received into the home, and disposals are not always appropriately recorded so drugs could go missing. Medication was missing on both of our visits or could not be accounted for. One person faced an infection control risk when staff counted drugs without gloves. Management could not find a pill counter in the treatment room, where there were also no gloves. The home did not arrange for alternative supplies, recognise the risk or act when our concerns for people were made known. Urgent requirements were made and management confirmed action was taken after the inspection. There were gaps and inaccurate medication administration records, and examples of people not having medication as their doctor intended. Staff confirmed there was no liaison with doctors about this, and no individual guidelines were seen for medications Care Homes for Older People Page 16 of 43 Evidence: prescribed as required or for variable doses. One inspector was told there was no one administering and managing their own medication in the home. Another inspector found several people doing so who did not have an assessment or monitoring to ensure this was stored and used as prescribed and safely for their own and others wellbeing. Medication is not auditable because of poor record keeping and administration practice. We were told there are regular internal and external audits of medication, but were not provided with legible examples, and clearly these are not thorough or effective. Medication audits are delegated to a Senior Carer. We were told that staff are appropriately trained and checked as competent in administering medication, but saw no written evidence of this and had conflicting management explanations. We found that there is a lack of accountable management oversight and leadership for the medication system, and in assessing and managing staff competence and knowledge. Care Homes for Older People Page 17 of 43 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people are able to make choices about their lifestyle, their appearance and have opportunity for mental and physical stimulation within the home. There is a balanced diet that meets most peoples needs, but the home must improve provisions for special diets and how peoples nutritional needs are met. Evidence: Some relatives think there should be more activities. People are satisfied and some told us they do not want to participate or go outside the home. There are birthday and holiday celebrations, religious services and occasional entertainment in the home. There are opportunities to take part in a variety of activities, and we saw an activity programme on display but no individual plans agreed with people. One person attends regular activities outside of the home. However people only go on outings if relatives take them and the home needs to make more opportunity for people to use community facilities to continue their interests and lifestyle. Staff help people to maintain important relationships and keep relatives updated. Visiting times are displayed at the entrance. A private phone can be made available. Some people carry their own mobile phones and one person has a personal computer, Care Homes for Older People Page 18 of 43 Evidence: to keep in touch with people of their choosing and with the wider community. People make choices about their clothing, appearance and finances, door locks, and there are curtains in double rooms for privacy if they are shared. People and families said: I enjoy bingo with the help of staff...have trouble with my eyesight. I like to stay in my room watching sport. ...x...goes to a day centre 3 days a week, and visits our house every other weekend. Generally the home supports people to retain their mental and physical skills and their appearance. People said they particularly enjoy exercise to music. During our visit a hairdresser provided services - cutting took place in the hallway which did not appear dignified, although hair is washed in peoples own rooms. There are a few younger adults and one person was well assisted by staff to recover from surgery. Health needs were reviewed but not social care needs to help them return to live in the community successfully. A programme should be in place to support them to regain independent daily living skills and avoid self neglect on their discharge. Flexible routines mean people get up, go to bed, and choose what and when they want to eat each day. When peoples preferences change these are put in a communication book, so that all staff are aware. But one person told us they are sometimes left in bed until noon such as on our visit, and they prefer to get up at 7 am; their care plan needs updating. Some mealtimes are set, and there are people in the home who need to avoid long gaps between meals. They did not have care plans about this and some would not all be able to ask for a snack. The food is well liked and nutritious, and there is a 4-week rotational menu. In resident meetings the home has listened to people who wanted alternatives to sandwiches at tea time, and a wider range of cold and hot food is now available. There is choice of a cooked breakfast, and at dinner time people sometimes have a choice of meat/fish or can have a jacket potato. Care staff cut up or mash food so people can continue to feed themselves. We saw others needing more support sensitively fed or prompted without being rushed. People with sensory impairments would benefit from plate guards so they could eat without spilling food in their laps. Staff did not know what these are, but management told us they are available in the home. One person with swallowing difficulty was referred to a health specialist. During the inspection we toured the kitchen, spoke to staff and observed a mealtime. Care Homes for Older People Page 19 of 43 Evidence: We fedback concerns to management about how peoples dietary and health needs are being met. Catering staff are not aware of people in the home at malnourishment risk needing food fortification. Care staff confirmed they mash but do not fortify food. We were told food is probed to see if it is cooked to a safe temperature, but there are gaps and inaccurate records. Only menu choice is recorded and daily records do not always note appetite and portion size consumed. Food was all mashed together so the person could not distinguish the food or choose not to eat something. Someone with diabetes chose their pudding and told us it was diabetic ice cream and another person with unstable diabetes was fed two bowlfuls by staff. The cook however told us there was no diabetic ice cream in the home and had not made staff aware of this. We saw out of date food in the fridge that had been removed by the inspection end, but note from the homes records that this is a recurrent matter. There are recent council food safety requirements. We cannot confirm that peoples dietary needs are met. Care Homes for Older People Page 20 of 43 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no recorded complaints; people do not have accurate information to report concerns and complaints outside of the home. People are safe and staff are checked to work in the home. Training and managment systems need to improve so that peoples rights are protected, and lawful decisions are made with them about restraint. Evidence: People told us that they feel safe. We were told about but did not see that there are a number of policies and procedures that protect people by safe working practices. The AQAA told us that Abercarn aim to be a complaint free service. There were no complaints recorded in the home and none have been reported to CSCI. In the main, people and their relatives told us that they know how to raise a concern or complaint, but two did not know or told us they were confused about this. We saw a complaints and compliments poster with timescales and clear process displayed in reception and in the service user guide but with incorrect CSCI contact details and none for the local council complaints process. So people will not have accurate information if they want to report a concern to an outside body. The service user guide explains how peoples rights are promoted, such as access to advocacy (no contact details) and the right to vote. In case-tracked records it is not clear how these rights are met. People have the right to their personal possessions and Care Homes for Older People Page 21 of 43 Evidence: we found a large pile of clothing and slippers in a room upstairs. Staff said labels are missing, but management saw some items were clearly labelled. Care records do not have up to date inventories of their possessions. Staff have not been trained in new laws about peoples rights which we previously recommended. Not all care plans and changes are signed by people, which tells us that people may not be participating in discussion and review of their needs and how these are met, including risk taking. There were a number of examples where recorded consent is necessary, or recorded best interest decisions under the Mental Capacity Act, such as for physical and chemical restraint as the least restrictive option. Restraint without lawful consent is abusive and some forms are crimes. Safeguarding people is usually taken seriously at Abercarn. There have been no adult protection concerns since that last inspection. Management made a report to a government list, as required by law, to conclude a previous matter so that vulnerable people can be protected in the care industry. Staff are appropriately checked to ensure they are safe to work in the home. We were told that the Head Office ensures any temporary staff are also checked. Staff have basic induction and training refreshers in abuse awareness. Staff we spoke to know what to do if a concern is expressed to them or if they see poor practice. They can describe abuse but did not recognise concerns from sources outside the home. For instance, we found that the home assist people to secure and manage money, and this is well accounted for. However people who do not have access to money or goods in kind need consideration as possible adult protection concerns, as well as unexplained falls and injuries in addition to notifying CSCI. We saw a chart in the office of the homes adult protection process which is linked to two councils and a PCT. There may be confusion about which council to report concerns to. CSCI contact details are also out of date. Management are aware of council training, but we are unclear if this is being used. Care Homes for Older People Page 22 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People bring their own possessions and rooms suit their needs, but privacy could improve if every room has a door lock. Toilet facilities are not meeting everyones needs and one person feels isolated in their room. More oversight is needed to ensure the home is hygienic, cross-contamination is prevented, repairs are timely and food is safe for peoples health. Evidence: Abercarn is in a residential area. We toured the home and discussed the environment and equipment with people, staff, visitors and management. Bedrooms are personalised and people can bring their own possessions. There is sufficient storage space so that there are no hazards. People have the equipment they need, maintained by the home. One person prone to pressure sores said an uncomfortable pressure mattress was changed, but the rubberised bumpers stick to their skin. There are privacy screens available for shared rooms. People must ask to have a lock on their bedroom door, rather than the home providing this as a matter of course. This means that people on short stays may not have the same level of privacy as other residents. Since the last inspection a shower was installed upstairs, giving people bathing choice. Care Homes for Older People Page 23 of 43 Evidence: Staff said people do not often choose the shower as the water pressure is a dribble, and staff do not find it easy to use because of an incline and they get wet. There are toilets conveniently located throughout the home but they are all too small for one person, their wheelchair and a hoist. This person feels isolated in their room where they take all their meals. They had to wait for an appropriately sized commode and are considering moving because the homes facilities do not provide them with sufficient independence and quality of life. They feel unable to use communal areas in the home daily, such as the dining room and lounge, in case they need the loo although they did come to a celebration. Staff forget to ask if they want their door open so that people or staff can stop to talk. Management are aware that this person does not have equality of opportunity in the home, but there is no plan to improve this. There were improvements regarding laundry and cleaning, but also infection control, fire evacuation and food safety risks. There has been no outbreak of contagious infection or illness in the home. We saw a cleaning schedules that has not been completed since August 08; we cannot therefore confirm that the schedules are being maintained. We were told that cleaning takes place day and night, and that management have not always instructed staff to maintain the charts. Some best practice was evident, such as colour-coded mops and secured COSHH chemicals. There is a recurrent problem about out of date food in the fridge, gaps and inaccuracy in food safety records. The laundy and sluice, based in a separate building in the grounds, was completely refurbished. There is an ironing room upstairs in the home that is also used to store cleaning equipment, which was propping open the door on our visit and was too close to clean laundry. In the hall we found clean and dirty laundry on the same trolley, and another trolley of soiled laundry with its lid open for several hours, causing malodour. We found clean laundry left alone in the lift that is frequently used by people and staff. Action was taken during and after the inspection to remedy risks we found by touring the home. Management told us in the AQAA that they want to improve infection control but we found their approach has not been timely or thorough. Care Homes for Older People Page 24 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are safely recruited so people are in safe hands. There appear to be sufficient staff, but we cannot confirm that they are trained for their roles, and are competent to meet peoples needs. Evidence: There is an ethnic and gender mix of staff so that there is a choice of care worker. People said they have good care and staff who respond when needed. Staff said there are usually enough staff, including good cover arrangements and temporary staff for leave or illness. Care workers undertake domestic and catering tasks as necessary. The AQAA shows us that there are less care staff hours provided for occupancy levels that have not significantly changed over several years. Staffing levels and skill mix must be kept under continuous review and match the assessed needs of people living in the home. There appeared to be sufficient staffing during our visit. One relative said, It appears they have all the right skills...I have found the care is excellent. Professionals told us that staff usually have the right skills and experience. National minimum standards are exceeded regarding staff qualifications at NVQ level 2. There do not appear to be opportunities for staff to undertake higher qualifications, which is of concern as management tasks, such as audits are delegated to others. Staff told us that they have a good induction and sufficient training. Care Homes for Older People Page 25 of 43 Evidence: Records did not confirm that national minimum standards about training and refreshers, appraisal of staff performance and supervision are being met. Two staff records do not show that manual handling or first aid training has been attended. Management confirmed that there has been a problem in staff attending mandatory training that they are addressing. Management must assess the depth of training in accordance with staff roles. Training is planned in November 08 about first aid, but it was not clear to us which level this training comprises, and which staff need to attend. So we cannot confirm there are first aiders on each shift who can respond appropriately to emergencies. This is of concern for someone with diabetes and frequent hypos, which can be life threatening. Medication awareness training has not been provided to staff who witness medication. Following the inspection management informed us that further medication training is planned. Learning opportunities and care plan guidelines for staff about peoples conditions and about medication were not seen. This means that staff may not have sufficient knowledge and information to monitor peoples health , and may not have sufficient training to use peoples equipment and help them mobilise. Supervision is not held at least six times a year, as required. We saw annual appraisals of staff performance in two out of three staff records, but one was not dated and both did not include medication competence based upon observations of practice. A requirement made at our last inspection is not met. Some staff have worked in the home for many years. We confirmed that new and long standing staff have appropriate checks carried out to ensure they are safe to work with vulnerable people. Temporary staff are used regularly and management told us that the Head Office confirms that they have been appropriately checked and trained. There were either no staff photographs or they were of poor quality in the staff files seen, and these are required by law. Induction checklists in staff records are good practice. Staff in the main say that management support them. They have functioned as a team for lengthy periods without a manager in place and have developed methods of working together so that peoples care needs are met. They told us that systems are not always timely, such as repairs, and that they resent being questioned unnecessarily when essential supplies are requested. This makes them disinclined to ask. Staff are becoming disaffected. This may effect peoples experience in the home if not managed. Care Homes for Older People Page 26 of 43 Care Homes for Older People Page 27 of 43 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples views about the running of the home are listened to and acted upon. Quality checks and management accountability need to improve working practices and teamwork to eliminate unnecessary risk to peoples health, welfare and safety, and take action on regulator reports. Evidence: Over the past two to three years, Abercarn had an acting manager in post twice, for six months apiece. One manager told us they were not always supported in their role, supernumerary hours were reduced, and opportunity to train and register with CSCI were hampered. Cotdean told us that a permanent manager has not been confirmed beyond a probationary period as one resigned and another was unsatisfactory. The AQAA was completed on time by Head Office and provided the information required. We were informed about the interim management in place in August 2008 a qualified and experienced ex-manager of another home, supported by the Cotdean Care Homes for Older People Page 28 of 43 Evidence: Director of Nursing. The acting manager is supernumerary two days a week, and on the care rota two days of the week and it is intended to continue this arrangement with a new manager and seek CSCI registration. The acting manager was not present on our first visit and did not want to accept accountability on our second visit for matters that may have breached regulations. Inspectors were supported by a variety of helpful staff, including the Director of Nursing, none of whom could provide us with fully satisfactory explanations or documents we needed. Some were sent to us after our visit. Cotdean confirmed charts we saw, delegating responsibility for management roles and other tasks to specific staff. For example, the accident and incident audit and medication audits are delegated to Senior Carers; infection control and health and safety audits are delegated to the management. We were not provided with evidence that these are being carried out and acted upon in a timely way, or that staff not trained in management are appropriately supported and overseen to do so. We found, from examples throughout this report, that there is insufficient leadership, management accountability and oversight at Abercarn and by Cotdean to ensure the home is run in peoples best interests. Two inspectors were told that the policies and procedures we requested were not available on the premises and could not be found at Head Office. So these are also not available to guide staff. The same was true of other documents that legally need to be on the premises. Interim management could not explain why systems in place are not being used and were not aware of this until we brought it to their attention. Legally required unannounced visits and reports of these by Cotdean, were not on the premises as required. These spot checks cannot be effective in light of ongoing deficiencies in other home records. The latest home audit provided is dated July 08, showing us that until then management undertook checks, for example that care plans are up to date, weighing people took place, and medication audit. There were areas of concern then about food safety checks, maintenance outstanding from May 08, care plans not being signed or sufficiently addressing nutritional risks. If there are medication audits now, they are not eliminating risks to peoples health and wellbeing. Recording standards are not maintained or checked, information about the home is not accurate for the public. Quality self checks are under developed and will not improve the quality rating of the home without management accountability and direction for teamwork. Peoples views are sought through surveys and meetings, and some problems are solved by staff with people in the home, and through staff meetings. Care Homes for Older People Page 29 of 43 Evidence: There is a new approach to ensure staff attend mandatory training. We saw a poster warning staff that they will have to re-pay costs if there is non attendance. There is insufficient staff supervision and appraisal of their knowledge and performance in relation to their roles. Management are not enforcing matters under their employment policies and procedures. There is a fire safety risk assessment in place, but we found a fire evacuation risk not reported to management (see Environment). There are current requirements about food safety made by the council. Although management told us in writing that other regulator requirements and safe working practices are met/maintained, our own findings show otherwise. Standards have slipped, and during the inspection presented unnecessary risk to peoples health, safety and welfare. Interim management by two qualified nurses has, for instance failed to ensure that there is a safe medication system in the home, competent staff, care plan evaluations about conditions and peoples health. We found that peoples financial interests are protected by the homes accounting system, but the home needs to improve partnership working to fully safeguard peoples interests. Health professionals told us that there is a homely atmosphere, caring staff, and that people are generally well looked after. People feel safe and we saw that staff usually have the best interests of people at the forefront of their practice. There is a lack of equal opportunity for a number of people in the home and management have not analysed this or included this in their strategic planning. Some action was taken by the interim management to address concerns we raised during the inspection, but this was insufficient to eradicate unnecessary risks even between our visits. We will require an improvement plan to ensure standards are maintained as safe. Care Homes for Older People Page 30 of 43 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(1) The registered person and 01/01/2008 manager must ensure that care plans reflect all resident individual needs and give full instruction for staff on how to care for each need for examples being; oral care, personal care, pressure area care and all risks identified from risk assessments. (Timescale of 19/02/07 and 01/01/08 is not met) It is the homes responsibility to notify the CSCI when this requirement is met. 2 7 15(1) 1) To ensure care plans 01/01/2008 contain full information and guidance relating to complex needs such as diabetes, Parkinsons disease, dementia and includes, diet, foot, eye, skin care. 2) To include fuller details of care provided in short term care plans, such as increased fluids, increasing attention to continence, additional skin care and mobility It is the homes responsibility to notify the CSCI when these requirements are met. Care Homes for Older People Page 31 of 43 (Timecale of 01/01/08 in Not Met) 3 8 13(1)13(4) 1) To ensure that any 01/01/2008 resident with significant weight loss, poor appetite or assessed as nutritionally at risk is referred to the GP and community dietician for advice and support 2) To ensure records of residents food / fluid intake demonstrate adequate nutrition, any fortified meals, food supplements and action taken where there is concern 3) To ensure records of personal care are fully accurately recorded 4) To review the Waterlow score of resident with pressure ulcer, which indicates an improved score, rather than identifying increased risk 5) To implement turn charts, food / fluid intake charts for any resident identified to be at risk 6) To ensure all residents have a base line weight (or MUST score) on admission and have records of regular weight monitoring It is the homes responsibility to notify the CSCI when these requirements are met. (Timescale of 01/01/08 is Not Met) 4 9 13(2) The registered person and manager must ensure that 01/01/2008 Care Homes for Older People Page 32 of 43 prescribed topical preparations; Are kept in a lockable facility if stored in the bedroom. Are entered onto the medication record and evidence maintained of when applied. (Timescale of 29/01/07 and 01/01/08 is not met) It is the homes responsibility to notify the CSCI when this requirement is met. 5 9 13(2) 1) The process of updating and expanding the homes medication policy and procedures must be completed 2) To ensure there is an upto-date medication list in residents case file / care plan 3) To agree arrangements with individual residents for the administration of weekly dosages of Allendronic Acid 150mgs to be taken half an hour before first food or drink and following advice for administration 4) To ensure Levothyroxine is administered before the residents have first food of the day 5) To ensure Calogen is refrigerated once opened and labelled with date of opening and use by date (within 14 days) 6) The registered persons must liaise with the appropriate G.Ps to ensure 01/01/2008 Care Homes for Older People Page 33 of 43 that prescriptions carry more specific directions for the administration of service users medication as opposed to `as directed. 7) To obtain and use a drugs fridge thermometer and record the daily minimum and maximum fridge temperatures (to be maintained between 2C - 8C) It is the homes responsibility to notify the CSCI when this requirement is met. (Timescale of 01/01/08 is not met) 6 9 13(2) To ensure that all medication 01/01/2008 is administered as prescribed and medication records must be accurately completed with a signature to indicate administered or the appropriate code must be used for non-administration. (Timescale of 29/01/07 and 01/01/08 is not met) It is the homes responsibility to notify the CSCI when this requirement is met. 7 9 13(2) The registered person and 01/01/2008 manager must ensure that an individual care plan is in place for each resident who has their medication prescribed on an` as needed or `when required basis. These must give clear instruction to staff when these medications should be given. (Timescale of 29/01/07 and Care Homes for Older People Page 34 of 43 01/01/08 is not met) It is the homes responsibility to notify the CSCI when this requirement is met. 8 9 13(2) The registered person and manager must review the homes medication policy in accordance with the Royal Pharmaceutical Society of Great Britain guidance. (Timescale of 01/03/07 and 01/01/08 is not met) It is the homes responsibility to notify the CSCI when this requirement is met. 01/01/2008 9 15 16(i)17(1)Sch 1) To complete the revised 01/12/2007 edules 4(13) menus, in appropriate formats, ensuring residents current food preferences are included 2) To demonstrate that the new menus have been assessed by the community dietician to provide adequate nutrition and meet any special dietary needs for residents 3) To provide planned meals on the menus with options displayed for residents preferring alternatives or special dietary requirements 4) To ensure that there are detailed records to demonstrate nutritious food intake, especially for any residents nutritionally at risk It is the homes responsibility Care Homes for Older People Page 35 of 43 to notify the CSCI when this requirement is met. (The timescale of 01/12/07 is Not Met) 10 27 18(1)(a) 1) The registered persons 01/01/2008 must ensure that there are at all times suitably qualified, competent and experienced staff working at the care home in such numbers as are appropriate for the health and welfare of service users 2) The registered persons must formally assess and document residents dependency levels and demonstrate on the staff rotas that staffing levels are being maintained at adequate levels to meet residents needs It is the homes responsibility to notify the CSCI when this requirement is met. (The timescale of 01/01/08 is Not Met) 11 33 24 The registered persons must 01/02/2008 continue to develop the homes self audit/ quality monitoring processes to ensure that regular audits reveal conformance and nonconformance to prevent requirements having to be made by the CSCI. (Timescale of 01/02/07 and 01/02/08 is not met) It is the homes responsibility to notify the CSCI when this requirement is met. Care Homes for Older People Page 36 of 43 12 38 13(3) 1) The registered persons 01/12/2007 must implement thorough cleaning schedules for the kitchen area, with regular documented monitoring arrangements to ensure satisfactory standards of food safety are maintained at all times It is the homes responsibility to notify the CSCI when this requirement is met. 2) The registered persons must, as a priority, ensure that all legal requirements and recommendations identified in the Inspection Report from Dudley Directorate of the Urban Environment are fully met It is the homes responsibility to notify the CSCI when this requirement is met. (Timescale of 01/12/07 is Not Met) Care Homes for Older People Page 37 of 43 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, Care Homes 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 1 8 13 13(4)(c) Unnecessary risks to the dietary needs of people with diabetes must be identified and as far as possible eliminated. There should be detailed care plans with clear staff roles and instructions so that all peoples needs and risks are appropriately met. 14/11/2008 2 9 18 18(1)(a): Staff involved in the medication system must be competent in their practice in accordance with their role and the homes procedures. Competent staff ensure medication practice is safe and peoples needs are met and protected. 31/03/2009 3 9 13 13(3) The registered person must make suitable arrangements to prevent infection to people from contaminated prescribed 14/11/2008 Care Homes for Older People Page 38 of 43 medicines and homely remedies. Medication storage, handling and auditing should promote and protect peoples health and wellbeing. 4 9 13 13(2) Stagg check that prescribed medicine is available for administration, is in date and is labelled by a pharmacist. 14/11/2008 To ensure that the right medicine is administered to the person it is prescribed for. (Timescale of 14/11/08 is not met) 5 19 23 23(4): Lighting must be maintained in corridors and by fire exits. so that people can be safely evacuated in the event of fire. (Timescale of 14/11/08 is not met) 6 25 13 13(4): Temperature checks should ensure the shower is maintained within the council safe range. Scald risk to people from hot water needs to be prevented. 7 38 24A 24(a): An improvement plan 31/03/2009 is required to ensure action is taken to CSCI requirements. 31/03/2009 14/11/2008 Care Homes for Older People Page 39 of 43 The registered provider must be accountable for health, welfare and safety. 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 1 1 The statement of purpose must clearly set out all of the required information in Schedule 1, Care Homes Regulations 2001, and any amendments. Behaviour plans should be formed with peoples consent about behaviour that poses risk of self harm or risk to others and/or property. These should identify triggers, agreed detailed actions by staff and should be tried before sedation is considered. Homely remedies should be checked with the doctor and pharmacist to ensure they are safe in combination with other prescribed treatment. Individual activity and exercise plans should be drawn up with people that reflect peoples mental and physical stimulation needs, their lifestyle choices, and detail any necessary staff assistance for those who need help to participate. We recommend that people are consulted about hairdressing arranagements to ensure their dignity is being maintained, and about the use of community facilities so that they can continue their interests and community links. Systems in the home must ensure that peoples dietary needs are appropriately met, monitored and evaluated for peoples health. Detailed care plans including staff roles, clear communication about food supplies and food preparation should be audited by management. The complaint procedure needs to provide people with accurate information to report a concern outside as well as inside the home. The homes records should show how patterns are spotted and acted upon about minor complaints such as missing personal posessions, so that service quality is improved and peoples rights are protected. Management and staff need learning opportunities about 2 8 3 9 4 12 5 13 6 15 7 16 8 18 Care Homes for Older People Page 40 of 43 new laws and multi agency protocols in adult protection and mental capacity, so that peoples rights are protected and respected. 9 18 Policies and procedures should be reviewed and cross referenced in light of new laws and multi agency protocol. Theduty of care should protect people from abuse and neglect from any source, poor or unlawful practice, especially restraint. Facilities need to match the needs of people living in the home without discrimination so that people have equality opportunity to use communal areas rather than be socially isolated in their rooms. The toilet near the communal lounge and dining room should accommodate wheelchairs and hoists. Comfort could be improved if there are cloth covers on bedrail bumpers so that the bumper does not stick to peoples skin. Inventories should be updated, and the homes laundry service improved so that peoples possessions are returned to them in a timely manner and risks of cross contamination from all sources are avoided in the ironing room. All rooms should have door locks so that people can choose when they want privacy, including people having short stays in the home. Action plans should be formed by management to meet best practice infection control, food safety and hygiene standards using local expertise and government guidance such as Essential Steps and Better Food Safer Business. Staff photographs must be clear and in staff files, in accordance with all documents in Schedule 2 of the Care Home Regulations 2001. Staff need training and learning opportunities about peoples conditions, so that they can write and use guidelines, care and monitoring measures with understanding. Management arrangements should be reviewed to ensure accountability for supervision and running of the home and safeguarding peoples wellbeing. Management need to keep up to date on laws, protocols and best practice guidance. Policies and procedures need to be updated annually but those currently in place, and Regulation 26 reports need to be available on the premises and to CSCI when requested. Development plans for the home need to progress regulator reports, the homes quality audits, and address Page 41 of 43 10 21 11 22 12 24 13 24 14 26 15 29 16 30 17 31 18 33 19 33 Care Homes for Older People any direct or indirect discrimination so that facilities and services meet needs and provide people with equal opportunity. 20 38 Systems for cleaning, laundry, repairs, ordering supplies, and food safety need to be reviewed, used by staff and checked by management so that health, welfare and safety is sustained in the home. Care Homes for Older People Page 42 of 43 Helpline: 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 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 43 of 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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