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Inspection on 01/12/08 for Adamstan House Nursing Home

Also see our care home review for Adamstan House Nursing Home for more information

This inspection was carried out on 1st December 2008.

CSCI found this care home to be providing an Excellent 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.

What the care home does well

Staff said the manager was excellent. They said she had superb listening skills and always acted upon what people had to say. They said she was "supportive, good at her job, kind and caring and truly Honorable". They said they were provide with ongoing training and supervising and as a consequence were able to deliver high standard of care based on current good practice. People living in the home and their representatives were very positive in their comments about staff and services provided and comments included: "Matron and staff took us all round the home before I moved in and when I did I found out that staff are very caring and the services here are superb" "This home is perfect in every way, the food is cooked on the premises and is delicious the services are grand and we all know the staff think only the best is good enough for the residents"

What has improved since the last inspection?

The manager has updated all care plans to make them more person centered and staff said they feel the additional information recorded on the care plan enables them to interact better with residents as they know their backgrounds,interest etc . Contracts of residence have been revised and contain clearer information about the annual fees and the rights of the residents.

What the care home could do better:

The inspection was very positive and identified that the home work hard to ensure the comfort and good service provision to the people living there. All documentation held the necessary details however staff files could benefit from being put into sections to enable information to be found quickly and not "have to be searched for".

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Adamstan House Nursing Home 187 Mill Lane Sutton St Helens Merseyside WA9 4HG     The quality rating for this care home is:   three star excellent 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: User doesnt belongs to any group     Date: 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. the things that people have said are important to them: They reflect 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 25 Information about the care home Name of care home: Address: Adamstan House Nursing Home 187 Mill Lane Sutton St Helens Merseyside WA9 4HG 01744819815 01744850330 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Adamstan Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named service user under pensionable age may be accommodated within the overall number of registered places. The home is registered for a maximum of 34 service users to include:- *Up to 34 service users in the category of OP (Old age not falling within any other category). Date of last inspection Brief description of the care home The home is registered to provide nursing care for up to 34 older persons over 65 years of age and is situated in a residential area with good access to St. Helens town centre and local amenities The home provides accommodation over two floors and has 34 single bedrooms. A passenger lift and stair lift are provided for ease of access to the upper floor. The home is purpose built and offers single accommodation only. Service Users are encouraged to personalise their private bedrooms. The home benefits from a variety of communal seating areas to include a large lounge, separate dining room, library area, quiet room and a conservatory that provides a pleasant view of the gardens and lake setting at the rear of the home. All garden areas are accessible to the residents with outside seating and awnings and car parking facilities are provided to Care Homes for Older People Page 4 of 25 Over 65 34 0 Brief description of the care home the front and side of the property. The registered providers of the home are Adamstan Limited and fees are currently charged at #446.00.per week. Care Homes for Older People Page 5 of 25 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: three star excellent 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: The quality rating for this service is three star. This means the People who use the service experience excellent quality outcomes. An unannounced visit was made to the home on 1st December 2008 when discussions were held with the manager and staff and the people living in the home. Care plans and other documentation was looked at and a tour of the premises was carried out. The visit was just one part of the inspection. Before the visit was made the home manager was asked to complete an annual quality assurance assessment (AQAA) to provide up to date information about the home and the services p;provided. Questionnaires were also sent to staff and People living in the home and their representatives to find out their views about how the home was run. Care Homes for Older People Page 6 of 25 All information gained from the above methods were used to formulate this report. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 25 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 9 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff of the home make sure that people who wish to live there are provided with a full assessment of their needs and are provided with information about the home before they are offered a placement. Evidence: Examination of five care files showed that the home supply contracts and terms and conditions of residence to people when they came to stay at the home. Contracts were clear and gave full details of residents rights and what they could expect from the staff and services provided. Information gained from care files and surveys returned by people living in the home and /or their representatives revealed that contacts are provided and updated each year to reflect any changes in charges and services provided. Care files viewed also held details of assessments being carried out prior to a person being admitted to the home. Staff said they carry out assessments on everyone who requests a place at Adamstan House to make sure that the home has the staff Care Homes for Older People Page 10 of 25 Evidence: and equipment available for them meet assessed needs. Staff also said that they like the person to visit the home as part of the assessment to enable them to look around and see other residents and make their mind up if it is the right place for them. Residents spoken with said they had been assessed before they came to live at the home and were also provided with lots of information about the home and its staff and service provided. Comments included: Information was given for us to read and we were very pleased with it. it was clear and detailed Matron and sister gave us written details about the home and took us around and showed us rooms etc. We were able to make a choice as we knew everything about it. i@m glad we choose here because its wonderful I was given a full tour of the home and provided with good information. An assessment of need was carried out and then we were left to make our own minds up about the placement. We were never rushed or pushed into making a decision although it did not take long to decide it was the place for me. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans accurately reflect the heath and social care needs of the people living in the home and how these needs will be met. Evidence: Examination of the care plans and daily records for five people who live at the home established that the plans and records were up to date and accurately reflected the care and support needed and how it was provided. All records seen were clear and care plans and care reviews held signatures of all the people who had been involved in them being drawn up. Risk assessments were included in the care file and included moving and handling, skin and tissue viability, sight and hearing and other risk factors. The risk assessments held dates and times when they had been reviewed and/or amended. Discussions with people living in the home and their representatives and comments received via surveys were positive. Comments included: the care and support we get here is excellent Staff are so kind and caring I dont know what i would do without them Staff make me feel safe as they provide good Care Homes for Older People Page 12 of 25 Evidence: standards of care and show they are well trained to look after me Staff are caring and supportive at all times Staff do their very best to carry out our wishes i visit here most days and could not wish my mother to be in a better place. The ordering, storage,administration and disposal of medication procedures were discussed with the manager and senior nursing staff and they advised that they had very recently been subject of a pharmacy inspection which to their knowledge had been positive. Medication procedures and records appeared well managed and staff identified they were trained and knowledgeable to deal with the management of medication. No omissions were fund on medication record sheets and medication was safely stored in a designated room. People living in the home said they were treated very well by staff who respected them and ensured tier dignity and privacy was upheld. Comments included: Staff are always aware of the need to ensure we keep our dignity. Some people need to be assisted to get out of their chairs by a machine(stand aid) and when this happens staff will cover up the people legs with a blanket to make sure they can get up without showing their underwear and things I need to go to the toilet a lot and staff help me to do so without making me feel a nuisance Staff are good to us and treat us at all times with respect. Discussions with staff and observations of their practice indicated they were aware of individual needs wishes and capabilities and ensured they used systems to ensure that all individuals were treated with respect. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are provided to suit the wishes of the people living in the home. Meals are well cooked ,plentiful and varied to meet individual dietary needs. Evidence: The manager said the activities are arranged by a member of the care staff who has been designated the role of activities co-coordinator because she enjoys it and is good at what she does. All care plans held information about the needs, wishes,preferences and capabilities of the people living in the home and staff said they did their best to ensure that their daily routines and activities were arranged to enable each person to Maximize their days. Discussions with the people living in the home identified that they were able within reason to enjoy a lifestyle to suit them and they said they were offered choices of activity or left to occupy themselves. One person said that s/he liked to have a sleep in the afternoon, another said that s/he liked watching the television, playing cards or just sitting chatting. Visitors were seen coming and going from the home and comments from them revealed that the home provides choices to all the residents as to how they wish to Care Homes for Older People Page 14 of 25 Evidence: spend their time. Residents said their spiritual needs were met by church people calling at the home and they said that many members of the community called in to see them to let them know what was happening in the area. People said they went out with family and friends if they were able and felt staff encouraged and assisted them to maintain good contact within the area. People living in the home were observed during lunchtime enjoying a well presented meal which they said was very tasty but this was nothing unusual as all the food provided in the home was excellent. A few residents said they did not know what was on the menu but it was always a pleasant surprise when they sat down to eat their meals. Staff advised that a menu board was on show in the dining room which identified the menus and choices for day and staff also told each person what was on the menu to enable them to make choices. It was agreed that because of the varying memory spans of the people living in the home staff would also provide small individual menus to ensure each person could refresh their memory as and when required. Kitchen area and food stores were very well maintained and the home had been awarded a certificate of excellence for the high standards of hygiene of the kitchen. It was noted that the dining room had recently benefited from the provision of new dinging room furniture and redecoration and the area presented as being warm and welcoming. Residents comments about the food was very positive and included;I have never had a bad meal here yet and I have been here a long time The food is wonderful,tasty, well cooked and delicious I love coming into the dining room for my meals, it is better than any five star hotel,just perfect. Care Homes for Older People Page 15 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints policies are in place and residents know nay complaints will be listened to and acted upon quickly. Staff are trained in all aspects of adult protection Evidence: Adamstan House had a complaints policy and procedural guidance in the foyer of the home and copies were also provided in the service user guide. The manager maintains a complaints book and it was recorded that one complaint had been received since the last inspection. This matter did not relate to the care or services provided by the home and records show this matter had been resolved and actioned as per the homes complaints policy guidance. Staff records show that all staff have received training in the protection of vulnerable adults and discussions with staff and information gained from documentation revealed that staff understood all aspects of safeguarding people and were provided with ongoing training both in house and via St. Helens Local Authority to ensure all People living in the home were protected from abuse. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe well maintained environment which is pleasant, hygienic and well furnished. Evidence: A tour of the building revealed that it was clean, tidy and very well maintained. The fabrics and furnishings were of a good standard and it was noted that all bedroom furniture and dinging room furniture had been replaced since the last inspection. People living in the home said that the environment was one of warmth and comfort and the home was always spotless and smelled nice. The manager advised that the owners of the home were very good at ensuring any areas of the home that showed signs of wear and tear were quickly addressed and that fabrics and furnishings were updated as an ongoing process. The home has hand-rails and ramped areas to ensure ease of movement and mobility around the building and all bathrooms and toilets are equipped with aids appropriate to need. The communal areas of the home include three lounge areas a dinning room and conservatory, all areas having a good view of the well maintained garden areas. Housekeeping records revealed that the home had a thorough cleaning program in place to include the daily cleaning of carpets and floors to ensure the premises was clean, hygienic and free form any unpleasant smells. Care Homes for Older People Page 17 of 25 Evidence: Bedrooms were well furnished and personalized with residents being encouraged to bring in small furnishing ,ornaments and pictures to make the rooms more homely. People living in the home said they were comfortable and settled in their rooms and felt that the home proved excellent standards of decoration and hygiene. Comments included;This home is so well maintained the standards are so high, its better then some five star hotels I have stayed in The owner calls in most days and if she sees any fabrics or furniture that need changing they are replaced right away, tis a marvelous home The staff keep this place clean and fresh, its a pleasure to be here. Visitors to the home said the home was always clean and well managed and they enjoyed visiting as they knew they loved ones lived in excellent surroundings. Comments included: Its always nice to visit here as we know mum is safe and well looked after Staff make sure this place is warm, comfortable and well furnished, everyone here appears to be very happy Care Homes for Older People Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are carefully selected and well trained to ensure the people in their care are safe and well looked after. Evidence: Examination of four staff files established that all checks had been carried out prior to staff being offered employment to ensure they were suitable to work with vulnerable people. These included references from previous employers and Criminal Records Bureau checks (CRB). The files held all necessary information but would benefit form being indexed to enable information to quickly be obtained. Recruitment polices were clear and identified that equality measures were used to ensure all prospective staff were provided with a fair interview process. Staff training records indicated that all staff had received all mandatory training and staff who wished to continue with their personal development were able to pursue other training in able them to add to their knowledge and skills. Records show that staff turnover is low and the home provides consistency of staff. Staffing rosters revealed that the staffing levels and skill mix were more than adequate to meet the assessed needs of the current people living in the home. Seven Care Homes for Older People Page 19 of 25 Evidence: care staff two qualified Registered general Nurses two kitchen staff two domestic staff one laundry assistant and one maintenance person were on duty in the home. Staff said they felt valued in their role and said they were encouraged to develop their skills and attend training updates as an ongoing process. People living in the home said the staff were good, kind,helpful professional,good at what they do,excellent people who really care All staff spoken with and or observed carrying out their duties presented as most capable and showed commitment to the provision of high quality care for the people living in the home. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the very best interest of the people living there Evidence: The home manager is experienced in the care of older people. She is a Registered General Nurse (RGN) and has obtained her Registered managers Award. The management structure of the home is supplemented by the addition of senior nursing staff who will carry out the role of officer in charge when the manager is not on duty. The home demonstrates an open philosophy with residents and their Representatives through the use of surveys, meetings and discussions about how they feel about the food,activities and general support provided to them. Staff supervision continues to be used with all staff having one to one meetings on a regular basis. Supervision records indicated that staff are able to discuss both work and personal issues and are able to talk through their training and development needs. Care Homes for Older People Page 21 of 25 Evidence: All people living in Adamstan House said they were content with the way the home was run and felt they were consulted about their feelings and changes made accordingly. Comments received from residents were positive and included: This home is the best there is I feel very much at home here I am safe and well cared for, Its not home but it is certainly the next best thing The ,manager and staff are very good and make us feel special. Staff said the manager was Good at her job and made them feel valued. Comments form staff included: The manager knows her stuff, she is very approachable and we know we can talk to her The manager helps us to gain knowledge and she makes us feel as if we are doing a good job. She encourages us to develop our skills The matron is always available to us to assist if we have a problem and to give us guidance when we need it. She is very good at her job and is respected by the staff. Information gained from documentation in the home identified that the home ensures that all health and safety training and essential service safety checks are carried out by people who are competent to do so. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 23 of 25 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 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 15 It is recommended that additional menus are provided and placed on each table in the dining room to ensure that all people living in the home can remind themselves of what is on the menu each day. Care Homes for Older People Page 24 of 25 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. 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