Inspection on 13/05/05 for Adamstan House Nursing Home

This inspection was carried out on 13th May 2005.

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

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

Other inspections for this house

Adamstan House Nursing Home 01/12/08

Adamstan House Nursing Home 26/06/07

Adamstan House Nursing Home 18/07/06

Adamstan House Nursing Home 11/08/05

Adamstan House Nursing Home 03/03/05

Adamstan House Nursing Home 26/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Adamstan House 187 Mill Lane, Sutton St Helens Merseyside WA9 4SF Lead Inspector Diane Sharrock Unannounced 13th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Adamstan House Address 187 Mill Lane Sutton St Helens Merseyside WA9 4HG 01744 819815 01744 850330 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Adamstan limited Ms Julie Usher Care Home 34 Category(ies) of Old Age - 34 registration, with number of places Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 34 OP 2. The service should, at all times, employ a suitably quailified and experienced manager who is registered with the CSCI. 3. One named service user under pensionable age amy be accommodated within the overall number of registered places. Date of last inspection 3rd March 2005 Brief Description of the Service: The home is registered for 34 beds to provide nursing care for older persons over 65 years of age. The home is a limited company and the registered Provider is Mrs. A Stanaway, the Registered Manager is Mrs. Julie Usher.The home is located close to local amenities and has 34 single bedrooms and is fitted with a passenger lift. It has a variety of shared spaces, which include a dining room, communal lounge and quiet areas. 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. A large communal lounge and separate dining room, conservatory which also looks at onto a lake. It is set in gardens, which are accessible to the Residents with outside seating and lakeside views Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 6 hours and was unannounced. It took place as there had been no response to CSCI from the Provider regarding outstanding requirements made in March 05. A partial tour of the premises took place and staff training records and Resident care plans various other records were inspected. Most Staff on duty, 4 Residents and relatives were spoken with and a selection of comment cards were left and some have already been sent back to the CSCI offices. The Manager represented the home and Mr Stanaway visited during this inspection. All areas of the inspection and findings were discussed with the Manager at the end of this inspection. The Regulatory process was discussed with Mr Stanaway in relation to outstanding requirements. Mr Stanaway explained that he is in the process of preparing financial budgets and audits for the home which he intends to send to the CSCI which shows that the home is running at a financial loss which is of concern to the CSCI. What the service does well: What has improved since the last inspection? The home continues to consistently provide good standards of care. The Manager explained that the Staff have all done a “care of the dying pathway” course and are looking at moving towards implementing this in the home when needed. The Manager is continuing with National Vocational Training for Staff so that she will eventually have most Staff achieve this qualification. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2/3/5 The home provides a good standard of care and Staff carry out detailed assessments of each new Residents needs so that the appropriate care is provided at all times. The Requirement to give Residents contracts/terms of conditions has not been met. EVIDENCE: Residents were very happy at the home and one person explained that when they moved in as soon as they rang the Nurse cord bell, that Staff arrived very quickly to give assistance and still continue to do this. Relatives explained they can visit whenever they want and are always made to feel welcome. They also explained that when they came to view the home for their relative they noticed how friendly and welcoming everyone was and this is why they picked the home.. The only outstanding part of these standards is that the homes Owners have still not issued contracts/terms of condition, for Residents choosing to stay at the home. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7/8/9/10 There continues to be progress made within care plans which include details for health, personal and social care needs of Residents. Medication procedures were found to be in good order with a well organised medical room. The Manager is continuing in efforts to locate a Dentist for Residents at the home. EVIDENCE: The Manager feels the home really does offer a homely environment and 99 of the time the choice is given for the Residents to have their own personal lifestyle. Residents and Relatives were very happy with the care provided at the home, most people described the home as the next best thing to their own home, another Resident said that Staff always knock at their door before entering. One Resident said they were happy with their care plan. The care records seen had a lot of detailed information and the Manager explained that they were still developing the records to include the Resident or Representative signature to say they have seen and agreed to their care plan. Some Resident comment cards indicated they had not yet seen a dentist and one person said they would like to. The Manager explained recent problems in Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 10 trying to get a Dentist to take new Patients on their list and was still trying to organise this and taking advice from the local “advocacy service”. The home has its own medication store room which is kept locked. This area is managed by the Nurses at the home and was found to be very organised and well run. Staff explained that due to new legislation they are trying to contract with a licensed agency to take old supplies of medicines away from the building. One Nurse explained that they do not provide facilities to “self medicate” as the view was that most Residents are too poorly to do this. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12/13/14/15 Social activities and meals are both well managed and there are a variety of choices available for Residents, however some areas could be developed further to include access to menus and activity programmes. EVIDENCE: The Residents and Relatives are happy with the activities on offer and explained that they could just go to their bedroom if they didn’t t want to take part. The Staff explained that they try to organise an activity each day and try to do this between them. During the day of this unannounced visit the Staff were organising a video afternoon. It was noted that fresh supplies of cold drinks were openly available in the communal areas accessible to all Residents. A poster in reception gave details of a clothes party. Staff explained that the daily activity programme and monthly newsletter is usually displayed in reception but it was being reprinted to fit all the planned events for the month. The Manager organises 2 monthly Resident and Relative meetings and displays the minutes in reception but she explained that they have always had a poor turn out to them. One Residents comment card said they would like to attend so that they could talk about things around the home including the menus.. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 12 There were compliments about the food and Staff and Residents said that if they didn’t t like what was on the menu that that the Cook would just provide something else. The menu of the day is displayed on a large board in the dining room. The Cook acknowledged that the choices offered daily are not on the menu board, this was something that could be developed in a printed menu and included in ongoing Residents meetings which would provide further accessibility. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16/18 The home has a complaints policy that Residents , Relatives and Staff know how to use. Staff are trained in “Abuse Awareness” and know about the policies that should be carried out. EVIDENCE: Comments from Residents and Relatives said that if there were any “niggles” that they are always dealt with in a really good way. Staff described their policies and what they would do if there was a problem. The complaint record book had no record of complaints. The Manager has started a “grumble book” were anyone can record a grumble, comment of informal complaint at any time. The Staff on duty all described their recent training for making them aware of abuse and what steps to follow if they needed to carry out the policy. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19/23/26 The environment is well managed and kept clean and tidy. Sufficient equipment is available for the Staff to use in ensuring that the good hygiene and cleanliness levels are maintained. There were enough domestic Staff available to maintain the cleanliness of the home. There is an outstanding requirement regarding the home not producing a maintenance and decorating programme. EVIDENCE: Residents were very happy with the homes facilities especially their bedrooms and that they could bring a lot of their own belongings into their bedroom. The Resident comment cards said that they did not have locks to their bedroom door and chose not to have them in place. The Manager said that if a Resident did want a lock it would be provided, it was agreed that this offer would be included in the Statement of Purpose or Resident Guide. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 15 The home was very clean and tidy especially the sample of areas seen. The Domestic Staff say they have a good routine in which they work hard at achieving their work too a very good standard. Risk assessments were also seen and gave detailed information about any identified risks, these records would also benefit from a starting date and Staff signature and review date to show they are regularly looked at to ensure the safety at the home. The home did not have a maintenance and decorating plan to show a planned approach to all parts of the home which would keep the Residents and Staff informed of changes to the home, it should be developed as previously discussed to show compliance and to provide a structured development plan for the Manager to use for future planning of the home. Some baths still had scrapes to the enamel which needed attention to reduce risks of cross infection, they still need to be included in a maintenance programme to show whether they are to be replaced or repaired. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27/30 Residents and Relatives say they are very happy with the home and the care provided by Staff. There is no written assessment nor rationale as to why Staffing levels have been reduced by the Owner and an outstanding requirement has still yet to be met by the Provider. Supervision sessions are still being developed and not met in full. Training records should be developed to show ongoing evidence to meet this standard. EVIDENCE: Residents and Relatives say they are happy with the care and say the Staff are lovely. Everyone in the lounge was seen to be given a good level of care and respect, the atmosphere was very informal and happy were everyone was helped to feel comfortable. The Staffing rotas show an outstanding issue from the previous inspection in March 05 were the homes Care Staff levels are short by 2 hours in the afternoon compared to the homes printed staffing notice previously agreed with the Health Authority. There was no assessment or rationale as to why the levels had changed, however the Manager and Staff felt the levels were acceptable at present to give the care needed. The Manager agreed to carry out a written assessment to show written evidence that the Staffing levels are appropriate using a published assessment tool based on the present dependency of Residents at the home. Mr Stanaway felt that the Staffing levels were appropriate and acknowledged that the Company had not submitted information to the CSCI following the homes previous inspection in March 05 to show compliance with this regulation. Mr Stanaway agreed to an Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 17 extended timescale 27th May 2005 to meet this regulation and submit evidence in a detailed action plan to the CSCI to show compliance. Staff interviewed were very enthusiastic and motivated to do a good job and provide a homely atmosphere and give as much choice as possible. Most Staff had worked at the home for many years and offered a great stability to the workforce. Staff acknowledged they did not have formal supervision but they did have appraisals and they all explained that the Manager has an “open door policy” were they could go and talk to the Manager whenever they wanted or needed to. The Manager explained the forthcoming plans in implementing supervision. The way that staff are supervised must include opportunities for formal 1:1 time so that staff can discuss issues and develop care practices. The training records still need to be in place for Staff so that the home can give written evidence of each individuals training to date and a training development plan could then be developed so a planned programme for mandatory and developmental training can be organised with an appropriate training budget to enable each Staff Member to have at least 3 days paid training per year. Staff also described their progress and enjoyment of doing their “national Vocational training with the Manager explaining that most Staff will eventually have this qualification. Domestic Staff on duty explained they have already achieved their national Vocational training qualification. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31/32/33/38 The Manager runs a well managed Home. There is an outstanding requirement regarding the Owner not producing action to reduce risks identified in the homes own risk assessments for uncovered radiators. Regulation 26 reports have not been carried out by the Provider and a requirement has been made. EVIDENCE: There were many compliments from the Residents and Staff about the Manager and her open style of management especially in how respectful she was and always open to look into things. Student Nurses are regularly placed at the home and describe how the Manager helps them during their stay at the home and how much they learn during their stay at Adamstan House. Recently the homes Manager received a complimentary report from the placement authority for the Student Nurses Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 19 Staff explained that if they come across anything broken they record this in the maintenance book and the maintenance man calls regularly to carry out repairs which helps to keep the home in a good state of repair. One outstanding requirement from the previous inspection in March 2005 was regarding some “uncovered radiators” and the risk assessment identified various risks. One of the Owners called to discuss these outstanding requirements as the CSCI had not received any information from the Company to say whether they were meeting theses requirements. Mr Stanaway agreed to submit an action plan and update the risk assessment with an extended timescale of the 27th May 2005 stating what action he was taking to meet this requirement and to show evidence that he had taken steps to safeguard all parties at the home. On this unannounced visit some uncovered radiators in communal areas were warm to touch. The Provider has not submitted monthly reports to the CSCI in which they should document at least monthly visits to the home in which they review certain records and interview Staff, Residents and Visitors to the home. Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x 3 x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 4 4 x x x x x 2 Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23 2) Requirement Timescale for action 8/6/05 2. 25 13 4)c) 3. 27 18 1)a) The Responsible Person must produce an updated maintenance and decorating plan, including baths that currently have scrapes to the enamel/surface and submit this plan to the CSCI, Describing the actions taken to meet this regulation..(This was made at the previous inspection and the timescale is still as above.). 27/5/05 The Responsible Person must take appropriate action to reduce the associated risks as recorded in the homes own risk assessments for uncovered radiators. and submit an action plan to the CSCI, Describing the actions taken to meet this regulation...(this is an outstanding requirement from the previous inspection with an extended timescale). The Responsible Person must 27/5/05 ensure that the staffing of the home meets the ongoing needs of the Service Users, and submit evidence to the CSCI describing the actions taken to meet this regulation and carry out a written assessment to show Version 1.30 Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Page 22 4. 29 19 9)c) written evidence that the Staffing levels are appropriate.(this is an outstanding requirement from the previous inspection with an extended timescale) The Responsible Person must ensure all personnel files meet the requirements in line with Schedule 2 of the Care Home Regulations 2001 and submit an action plan to the CSCI, Describing the actions taken to meet this regulation... The Responsible Person must develop and issue to Residents, contracts/terms and conditions. The Responsible Person must submit Regulation 26 reports to the CSCI each month. 5. 6. 2 33 4 26 8/6/05(Thi s was made at the previous inspection and the timescale is still as above.) 8/6/05 8/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 38 9 15 12 1 8 30 Good Practice Recommendations To implement dates and signatures to all risk assessmenst to ensure they are all up to date. To develop policies for self medication and continue with recording of the storage of medications. To develop the choices offered with menus and the accessibilty of suitable menus. To continue displaying the orgsanised activities events in the home To include the offer of locks to bedroom doors in the homes Statement of Purpose/Service User guide. To update Residents on the present situtaion of accessing a dentist. To continue developing and updating training records and provide evidence of 3 days paid training for all Staff each year. F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 23 Adamstan House Commission for Social Care Inspection Burlington House, South Wing 2nd Floor Crosby Road North, Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Adamstan House F53 F03 S5446 Adamstan House V231274 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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