Inspection on 20/04/05 for Addenbrooke Care Home

This inspection was carried out on 20th April 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

Addenbrooke Care Home 12/10/07

Addenbrooke Care Home 19/06/06

Addenbrooke Care Home 21/09/05

Addenbrooke Care Home 19/11/04

Addenbrooke Care Home 22/07/04

Addenbrooke Care Home 25/02/04

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

CARE HOMES FOR OLDER PEOPLE Addenbrooke Care Home Willis Road Gosport PO12 1NA Lead Inspector Anita Tengnah Unannounced 20/04/2005 10:00am 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. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Addenbrooke Care Home Address Willis Road, Gosport, PO12 1NA 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) 023 9258 1088 Hampshire County Council Ms Susan Webber CRH 35 Category(ies) of DE(E) - 35 registration, with number of places Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 19/11/2004 Brief Description of the Service: Addenbrooke is a registered care home providing personal care to 35 service users in the older person category. the home is situated close to the town of Gosport,the water front and some local amenities. Accomodation is provided on two floors with a passenger lift that allows access to all areas. All the rooms are single and have washhand basins fitted in all bedrooms. The service also benefits from gardens that are enclosed and accessible to service users. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection took place over one day on the 20th of April 2005. As part of the inspection process a tour of the building was undertaken. The inspection lasted over 7 hours. The inspector spoke to 11 service users, 9 staff and the manager. There was no visitor to the home at the time of the inspection. The process included examining care records, staff records and discussions with service users and staff. What the service does well: What has improved since the last inspection? What they could do better: Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 6 Pre assessments and review and updates of care plans including manual handling assessments should be undertaken in order to reflect and meet the current needs of service users. The employment of casual staff must be reviewed and ensure that they are supported, inducted regarding emergency and fire safety procedures so that such employment do not impinge on the quality of care and the safety of service users. Staff morale and workload could be improved by ensuring that there are adequately trained staff and in sufficient numbers to meet the needs of service users at all times. This would ensure that care needs are met appropriately and not rushed. Records of agency staff should be maintained to ensure that all proper checks are undertaken and records reflect current status with regards to mandatory training as appropriate. The refurbishment of the two bathrooms that remain outstanding as required from previous inspections should be completed in order that they compliment the service and provide a homely atmosphere. A review of towels provided to service users is urgently needed as those seen were frayed and torn. The home must also ensure that there are adequate towels, sheets as required by service users. A procedure ensuring that all clothing is labelled is needed to ensure that service users wear their own clothes. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 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 Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 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) 3,6 The lack of pre-assessment does not demonstrate how the home can ensure that service users needs are met. EVIDENCE: The home has a statement of purpose and service users guide and a copy of this is available to all prospective service users. Record seen showed that care management assessments are available. There was no record of any preassessment undertaken by the home prior to admission. Prospective service users are offered the opportunity to visit the home. The manager reported that most of the service users are known to the home as they attend the day service in the ground. However the day care service is run independently to the home and staff reported that have little contact with these service users. The home does not provide intermediate care. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 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) 7,8,10 Care plans are available within the home, lack of detailed care planning and review to ensure that all service users needs are met have the potential of placing service users at risk. Service users commented that they like living at the home and staff were observed to interact well with them. EVIDENCE: Arrangements were in place such as care plans and manual handling assessments. Pen portraits were also included as part of the process of getting to know them better. Some progress has been made as the home has started a new care planning system. Care plans seen showed that there were insufficient details to inform practice in particular with the activities of daily living. This was particularly a problem highlighted by agency carers that had responsibility of managing their care. Manual handling assessments were dated 2003 and had not been reviewed or updated to reflect their current needs. Care plans seen were not reviewed on a monthly basis or sooner to reflect any changing needs of service users. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 10 A number of service users spoken to said that they liked living at the home and that they were treated well and staff were kind. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 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) 12,13,15 The staff have a good understanding of service users support needs and positive relationships have been formed by long standing staff and service users. Meals are well managed and service users are supported with meals as required. EVIDENCE: The home has two support workers that are responsible for coordinating activities for service users. This was observed to be interactive and service users reported that they enjoyed the daily activities. Service users were enjoying an art and craft morning with the help of an external person from the college. A group of children from the local school attended the home in the afternoon of the inspection and were assisting service users in the “Sea Britain” project that related to making a wall hanging of seaside theme. There is open visiting policy and this was evidenced by the visitors’ book maintained at the home. Meal was observed being served at lunchtime and appeared nutritious, well balanced and was nicely presented. Staff were available to offer support with meals in a sensitive manner. A daily menu was displayed in each unit. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 12 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 satisfactory complaint system. Appropriate training in Adult Protection is in place for staff. EVIDENCE: The home has a complaint procedure in place and a log was also available. The manager deals with all complaints. The home received 2 complaints since the last inspection that has been resolved. A review of the recording procedure is required as date regarding 1complaint received was not available. All correspondence relating to a complaint investigation should also be maintained and could not be determined if it was completed within the timescale. The home has in place the Hampshire Adult Protection procedure. The manager is aware of her responsibility to record and report all allegation of abuse to the appropriate authority for investigation. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 13 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) 19,20,2124,26 The overall quality of the décor and furnishing is good. Refurbishment of the bathrooms and the quality of towels need improving to ensure that these are adequate and meet the needs of service users. Procedure for infection control and elimination stain and offensive odour from furnishing is lacking. EVIDENCE: A refurbishment of the entrance hall has been completed and a mural depicting the local pond has generated animated interests from service users. Seating was also available in the entrance hall and there is free access to other communal areas as this area has been opened out. Furnishing was of good standard and appropriate to service users needs. Most of the rooms were personalised. It was noted that most part of the home was clean except for one area as identified at the time of the visit where furnishing was stained and offensive smell present. The assistant manager reported that night staff would attend to this and furnishing would be steamed clean to eliminate odour. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 14 The home has adequate washing and bathing facility. A requirement was made regarding the refurbishment of 2 bathrooms at two previous inspections. These remain outstanding and the manager reported that work on these planned for this year. The home has gardens to the side and back of the service that are accessible to service users and are secure. Seating is also available in the garden area. The home has a laundry in place and all laundry is undertaken internally. Infection control system was in place, however staff reported this was not always followed and foul laundry were not placed in appropriate colour coded bag. It was noted that towels were in very poor condition as these were frayed and torn. Staff also reported shortage of towels and “kylie” sheets. This was discussed with the manager who gave assurance that there was adequate stock of both. An audit of these should be undertaken and these items should be replaced/ increased as appropriate to meet the needs of service users. A system for labelling of service users clothing should be developed. Not all clothing was labelled and staff reported that this was dependent on staff memory in identifying those unlabelled. This has the potential of service users wearing other people clothing. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 15 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) 27,29. Staff moral remains low due staff shortage and high staff turn over that does not offer consistency of care to service users. This has the potential of placing service users at risk. The lack of induction for agency carers can be detrimental to the safety and welfare of service users. EVIDENCE: The home has a rota for carers and a separate duty rota for ancillary staff. The home has been relying on agency staff to provide cover. Staff spoken to comment that morale remains low due to staff shortage and use of agency carers. This in turn according to permanent staff compromises the care delivery for service users. This has also been highlighted in report as per Regulation 26 from the Responsible Individual. Agency carers reported that they are left in charge of the unit with little support and are vulnerable. Staff reported that there was difficulty in supervising service users as often they attend the other unit to offer help to their colleagues. One carer was allocated to each unit with 7-8 service users. Record shows that one agency carer who started on Monday had a short induction, however there was no record of induction for 2 other agency carers that were on duty and responsible for care in the unit allocated. Another agency carer reported that she had received no induction regarding emergency procedures including fire safety at the home. Some agency staff records were inadequate. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 16 There was inadequate record of service users dependency assessment in order that an informed choice can be made regarding the number of carers required to meet the assessed needs of service users. Comments from staff included feeling “stretched”, “rushing” service users in order to meet the demands. Permanent staffs commented that they liked their jobs and have developed good rapport with service users. Staff interacted well and treated service users with respect. The manager reported that the home has recruited 9 carers and 1 domestic staff and are waiting for checks to be completed. This was reported would provide a more stable work force once they have been inducted. Concerns were raised at the proposed review of staffing on night duty that there would no longer have a sleeping in/ on call on night duty. At present there are 3 waking staff and 1 sleeping in. The proposed review would in effect have only 3 staff on night duty. Staff records seen showed that permanent staff records were maintained as per schedule 2 and all checks were undertaken. Information regarding agency staff has improved however the home needs to ensure that up to date records of these staff are available and maintained to include dates and CRB numbers. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 17 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) 37 Service users best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Records were maintained securely. Reports as per Regulation 37 are submitted to the commission as appropriate. There were records of accidents/ incidents of service users maintained. The manager must ensure that service users records also contain these documents. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 2 x x 3 x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x x 3 x Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 19 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 7 Regulation 12(1) 15(1) Requirement The manager is required to ensure that care plans and risk assessments are reviewed and updated to reflect current needs of service users. (Timescale of December 2004 not met). Refurbishmemt of 2 bathrooms as identified at previous inspections must be completed. Action plan with timescale is required to be sent to the Commission.(Timescale of August 2004 and December 2004 not met) The provider must ensure that there are adequately trained staff and in sufficient numbers to meet the needs of service users at all times. The employment of temporary staff must not impinge on the quality and continuity of care provided to service users. The manager is required to ensure that all agency staff records are up to date and maintained as per schedule 2. Timescale for action 30/05/05 2. 21 23(2) ( C) 30/05/05 3. 27 18(1) 30/05/05 4. 29 7,9,19 30/05/05 5. Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Addenbrooke Care Home H54 S39545 Addenbrooke V221724 200405.doc Version 1.20 Page 21 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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. 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