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Inspection on 05/05/05 for Admirals Reach Residential & Nursing Home

Also see our care home review for Admirals Reach Residential & Nursing Home for more information

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

Nelson House provides a good standard of care, and residents have good access to local health services. Residents were very complimentary about the staff. One resident described the staff as "caring and attentive", another said "the standard of care is good and staff are very obliging", and a relative said "the devotion of staff is very special". Residents felt confident that any concerns raised would be addressed promptly.

What has improved since the last inspection?

Residents said that the standard of food had improved. One resident said "food is a lot better than it was and there`s a better choice". They were complimentary about the standard of cleaning and quality of the laundry, and felt that they were better than in the past. The standard and range of activities had improved. A relative said "there`s always something for them to do". Staff training was more resident focused, and as one member of staff said, "it makes you think what you can do better".

What the care home could do better:

Staff need to ensure that personal preferences, interests and expectations are fully discussed with potential residents before admission. Staff must encourage residents to take decisions about their level of independence and autonomy, following risk assessments and discussions with relatives and GP where necessary. A more appropriate placement must be found for the resident with challenging behaviour. Monitoring of residents` psychological health needed to be more detailed and consistent. The communal areas were due to be refurbished but no start date had been agreed.

CARE HOMES FOR OLDER PEOPLE Nelson House at Admirals Reach Nursing and Residential Home Ridgewell Avenue Chelmsford Essex CM1 2GA Lead Inspector Francesca Halliday Unannounced 05 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. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Admirals Reach Residential and Nursing home Address Ridgewell Avenue Chelmsford Essex CM1 2GA 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) 01245 266567 01245 280469 BUPA Care Homes (CRHCare) Limited Mrs Chipema Chitambala Care Home 120 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (30), Physical disability (30), Physical disability over 65 years of age (60) Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 5 persons) Date of last inspection 12 October 2005 Brief Description of the Service: The Admirals Reach site consists of four single storey, purpose built houses each accommodating 30 residents. Each house is staffed on an individual basis and the central services include administration, laundry and the kitchen. The home is situated approximately one mile from Chelmsford and within walking distance of the bus service. The home has a spacious car park. Nelson House is registered to provide nursing care for up to 30 residents over the age of 60 years, and up to 5 residents over the age of 40 years who have a physical illness/disability. All residents on Nelson are accommodated in single bedrooms with en-suite facilities. The majority of rooms overlook the landscaped gardens. Nelson has a dining room and four different sitting areas to meet individual need. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 5th May 2005. The inspection lasted 7 hours 25 minutes. The inspection process included: discussions with six residents, one relative, one visiting health professional and seven staff (including the charge nurse for Nelson House and the manager covering the home in the absence of the registered manager). The premises and a sample of records were inspected. 17 of the 38 standards were inspected: 1 exceeded the standard, 10 met the standards and 6 standards had minor shortfalls. The judgements made within the report are based on the observations and evidence gathered during this inspection. What the service does well: What has improved since the last inspection? Residents said that the standard of food had improved. One resident said “food is a lot better than it was and there’s a better choice”. They were complimentary about the standard of cleaning and quality of the laundry, and felt that they were better than in the past. The standard and range of activities had improved. A relative said “there’s always something for them to do”. Staff training was more resident focused, and as one member of staff said, “it makes you think what you can do better”. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.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. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.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 Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.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) 1, 3 and 4 (standard 6 is not applicable) The information provided by the home enables prospective residents and their representatives to make informed choices about the suitability of the home. The home generally has a good assessment process prior to admission. However, lack of documentation about personal preferences could potentially result in a mismatch between expectations and what the home can actually offer. EVIDENCE: The home has a range of information for prospective residents and their representatives. Staff use the BASOLL assessment (Behaviour Assessment Scale of Later Life) and an activity of daily living assessment as pre-admission assessment tools, but both tools were not always completed. There was evidence that preferences such as diet, social interests, family involvement and religious and cultural needs were not always ascertained prior to admission. However, residents and a relative expressed satisfaction with the admission and assessment process, and the way that the home was meeting care needs. The relative said “I would pick this home if I had to come in”. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 9 One resident who had mental health needs and challenging behaviour had been admitted since the last inspection. Nelson House is not registered to care for residents with mental illness and the staff are not mental health trained. The charge nurse confirmed that full details of the resident’s mental illness and challenging behaviour had not been made available at the time of the preadmission assessment. Re-assessments had been undertaken, with a view to an alternative placement. There was evidence of input from a multidisciplinary team, which included a consultant psychiatrist. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 10 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 and10 Residents’ health and care needs are met and they are involved in decisions about their care. They are treated with respect and their privacy and dignity is upheld. EVIDENCE: All residents spoken with during the inspection considered that the standard of care on Nelson House was good. The care plans were generally of a very good standard. There was evidence of detailed evaluations of care and care needs, and records of resident’s wishes in relation to their care. Residents confirmed that they were consulted, and involved in care planning and review of their care needs. Staff demonstrated an excellent understanding of residents’ needs. There was also evidence of good communication between staff. There was a record of one aspect of care in a separate book. However, on occasions this information had not been transferred to the resident’s individual record. The daily progress records were generally of a good standard, but did not always have sufficient detail. There was some monitoring of psychological health, but this was not consistent or detailed enough to enable analysis to be made from the records seen. There was clear documentation concerning the possible need for restraint for one resident, and the circumstances in which it Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 11 could be used. There was evidence of multidisciplinary input into the decision making process in relation to the use of the restraint. Staff said that they would always try to ascertain residents’ wishes in relation to how their care was given and whether it was given by a male or female member of staff, particularly in relation to the giving of intimate care. Residents confirmed that staff treated them with respect and upheld their privacy and dignity. There was evidence of systems in place to ensure residents had dental and optical checkups, and chiropody when necessary. There was evidence that residents had good access to local health services. A visiting GP said that they were very happy with the standard of care provided on Nelson House. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 12 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 and 15 Social activities are well organised and provide stimulation and interest for residents in the home. The meals are nutritious and offer a healthy and varied diet. Staff concerns to protect residents from risk could potentially prevent them from exercising control over their lives and being more independent. EVIDENCE: Residents said that the standard of activities in the home had improved, and that they could choose whether to join in the activities or remain in their room. There was evidence of both group and individual activities, and sessions involving exercise and physical activity. Residents had been involved in decisions about the development of the new sensory garden, and in potting up some hanging baskets. A number of staff agreed that the range of activities had improved, and they were able to demonstrate that they were trying to improve the quality of life for residents as well as the quality of care. One member of staff made a suggestion that the large open plan sitting room could be used to provide different activities or appeal to different tastes, for example television in one area and classical music in another. Nelson House has no restrictions on visiting, and the relative spoken with said that they were always made to feel very welcome. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 13 Staff were able to give some examples of how they encouraged residents to be independent. However, one resident who was waiting to move to their own home considered that staff restricted their independence, and said that the home had “too many rules”. A discussion was held with staff about the benefits of encouraging the resident to take responsibility for as much of their care as possible, following risk assessments where necessary. This could then form part of their rehabilitation and enable assessments to be made of the continuing care they might require on discharge. A discussion was also held about the balance between encouraging healthy eating as part of good care, and staff wanting to restrict a resident from eating too many convenience and snack foods. Residents praised the food, and said that the standard of food and variety on the menu had improved since the last inspection. A range of diets is provided. The chef confirmed that a number of alternatives were available and special food could be obtained on request. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 14 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 and 18 Residents have confidence that concerns are addressed promptly and that they are protected from abuse. EVIDENCE: The complaints procedure was on display, and staff were aware of the procedure for dealing with complaints or concerns raised with them. Residents confirmed that any concerns were investigated and addressed promptly. The charge nurse said that all staff on Nelson House had received training in the protection of vulnerable adults. All staff spoken with were able to demonstrate an understanding of the different types of abuse that can occur. One member of staff said that they would feel very confident in acting as an advocate for residents, and reporting any lapses of care observed. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 15 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, 24 and 26 Residents live in safe, comfortable and clean surroundings. EVIDENCE: All accommodation in Nelson House is in single rooms, with an en-suite facility. Rooms were well personalised to residents’ tastes and preferences. The charge nurse said that the communal areas were due to be redecorated and refurbished in the near future. Residents had been involved in the choice of furnishings. The charge nurse said that the money for the refurbishment had been allocated, but that he was not sure of the timescale for the work to start. The home was clean on the day of this unannounced inspection and there were no unpleasant odours. A relative said “the standard of cleanliness has gone up”. Residents praised the standard of the laundry service and said that the quality of the service had improved. However, they did say that their clothes were lost on a number of occasions. The laundry staff considered that this was usually due to the fact that they had not been labelled or that the label had come off in the wash. Residents confirmed that both laundry and care staff spent considerable time trying to locate missing items. However, one resident Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 16 said that they had not been reimbursed for items of clothing that could not be found. Laundry staff said that they had access to a limited range of chemicals and would like a more effective stain remover. There was evidence that both the domestic and laundry staff were taking pride in their work and were constantly trying to improve standards. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 17 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) 30 Staff training is directly focused on improving the care and services for residents. EVIDENCE: Although only some of the training records were inspected, there was evidence that the overall standard of training had improved. Staff were very enthusiastic about the training on offer. A number of staff said that they had benefited from the “personal best” training. They were able to demonstrate that they were now giving much more resident focused services and care. Some staff had also benefited from the dementia care training, and were able to apply some of the principles learned to the care of residents on Nelson House. One member of staff described the dementia course as “inspiring”. Comments from residents, a relative and a visiting GP confirmed that overall standards on Nelson House had improved. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.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) 32 Nelson House is well managed and run in the best interests of residents. EVIDENCE: The registered manager had been absent from the home for a number of weeks prior to this inspection. Two managers from other BUPA homes were providing management cover. Staff spoken with considered that the home had good management and support from the manager, and good leadership from the charge nurse on Nelson House. One member of staff described the charge nurse as “very approachable”. Staff said that there was good communication and that they acted well as a team on Nelson House. The majority of residents spoken with were very complimentary about the management on Nelson House. Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 19 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 3 x 2 2 x N/A 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 2 15 x COMPLAINTS AND PROTECTION 2 x x x x 3 x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x x x x Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 20 no 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 1 Regulation 14 Requirement The registered person must ensure that the pre-admission assessment covers all the prospective residents needs and preferences. Informed at the time of inspection. The registered person must ensure that the resident with a mental illness currently in Nelson House is found a more appropriate placement. The registered person must ensure that residents psychological health is monitored and recorded systematically when a need has been identified, and that sufficient detail is recorded to enable analysis to be made. Informed at the time of inspection. The registered person must as far as practicable enable residents to make decisions about their care and their level of autonomy within the home. Informed at the time of inspection. The registered person must confirm the timescale for the refurbishment of the communal areas on Neson House. Timescale for action 5.05.05 2. 4 4(3)(b) 15.06.05 3. 7 13(1)(b) 5.05.05 4. 14 12(2) 5.05.05 5. 19 23(2) 15.06.05 Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 21 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. Refer to Standard 26 26 Good Practice Recommendations The registered person should investigate the range of stain removers available, to enable laundry staff to provide stain free clothes for residents. The person registered should ensure that property lists are kept up to date and that clothes are labelled before they are sent to the laundry Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 22 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Nelson House at Admirals Reach Nursing and Residential Home I05-I56 S15345 Admirals Reach - Nelson V225064 050505 Stage 41.doc Version 1.30 Page 23 - 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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