CARE HOMES FOR OLDER PEOPLE
Admirals Reach Residential & Nursing Home Ridgewell Avenue Chelmsford Essex CM1 2GA Lead Inspector
Francesca Halliday Benbow House - Unannounced Inspection 6th February – 6th March 2006 10:00 X10015.doc Version 1.40 Page 1 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 Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 2 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. Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Admirals Reach Residential & Nursing Home Address Ridgewell Avenue Chelmsford Essex CM1 2GA Telephone number Fax number Email address Provider Web 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 www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Chipema Chitambala Care Home 120 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (60), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (2), Old age, not falling within any other category (30), Physical disability (30), Physical disability over 65 years of age (60) Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Jellicoe Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 30 persons) Two named persons with a mental illness whose names were made known to the Commission Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 30 persons) Nelson 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) Benbow Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 30 persons) Mountbatten 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 65 years and over, only falling within the category of old age (not to exceed 30 persons) The total number of service users accommodated must not exceed 120 persons 10th May 2005 Date of last inspection 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. There is a spacious car park. The home is situated approximately one mile from Chelmsford and within walking distance of the bus service. Benbow House is registered to provide nursing care for up to 30 residents over the age of 65 years with dementia. All residents on Benbow House are accommodated in single bedrooms with en-suite facilities. The majority of rooms overlook the gardens.
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was to Benbow House only. The unannounced inspection visit took place on 6th February 2006. The inspection lasted 5 hours 35 minutes. The inspection process included: discussions with 7 residents (although advanced dementia made communication difficult with a number of residents), 3 relatives and 4 members of staff (including the head of care of Benbow House and the registered manager). The premises and a sample of records were inspected. A further discussion was held with the manager on 6th March 2006 and this concluded the inspection process. The Commission had received two complaints since the last inspection. An additional inspection was carried out on 6th September 2005 to investigate one of the complaints. Details are contained within this report, under the section on complaints. 13 of the 38 standards were inspected: 1 exceeded the standard, 7 met the standard, 4 standards had minor shortfalls and 1 standard was not met. 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?
Considerable training has been given to staff since the last inspection. The management of challenging behaviour had improved, and staff were involving a multidisciplinary team in the decision making process when necessary. Staff had a better understanding of residents’ need for privacy, and rights as an individual, and were better at promoting this than in the past. Changes to the layout of the communal areas and an increase in the staffing levels in the morning, had resulted in improved supervision of residents on Benbow House.
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 6 The main communal lounge/dining area had been redecorated and refurbished, and was much improved. 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. Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Standards 1 and 3 were assessed as met at the last inspection on 10th May 2005 (standard 6 not applicable). Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10 and 11 The overall standard of care records is improving, but important aspects of care are not always documented. Relatives are confident that residents’ health needs are met, but staff do not always have the documentary evidence to back this up. Residents are treated with dignity. Staff have a better understanding of residents’ need for privacy, and uphold this better than in the past. Residents and their families are very well supported during residents’ last illnesses. EVIDENCE: The care plans were more resident centred than at the last inspection, and demonstrated an understanding of residents’ individual needs and preferences. Some excellent evaluations of care and care needs were seen. One of the care records sampled had clear information about the progress of healing of a wound. However, another resident’s file had no care plan for a very infected wound identified in the records in December 2005. There was no record of a visit from the GP (the resident had been prescribed antibiotics), and no records of the wound or any dressings done until over five weeks later, when the wound was described as having “lots of pus coming out”. There was evidence
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 10 that overall staff communication with relatives, about issues of health and care was improving, however, there was no record that the resident’s relatives had been informed about this wound. Staff reported that they had good access to local health services and very good support from their GP. Residents on Benbow House had access to hospital consultants if advice on symptom control was needed. There was evidence that staff were monitoring residents’ weight and offering additional snacks and supplements when nutritional intake was poor. A range of risk assessments was in use, and residents’ psychological health was being regularly monitored. Medicines were being stored appropriately and medicine administration charts sampled were well completed. The recorded balances of two homely remedies were incorrect. A few out of date items were disposed of at the time of inspection. There was evidence of discussions with the GP about disguising medicines in solid food, for a resident who tended to retain tablets in their mouth. The majority of staff had a very caring manner, and all staff were seen to treat residents with respect. There was evidence that residents were choosing to spend time in the privacy of their room when they wished. Staff had a greater understanding of residents’ need for privacy than in the past, and were much better at upholding and supporting their right to privacy. There were records of staff discussions with residents and relatives to ascertain their wishes for terminal care. A number of letters were seen, which were extremely complementary about the care given to residents during their last illnesses. One letter described “the care and devotion” of staff. Another described staff as “going beyond professionalism, (allowing residents) to retain a quiet dignity” during their last illness. Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 the following standard(s): 12 Training in activities is being provided, but the range and frequency of activities still needs to be improved. EVIDENCE: Benbow House only had input from an activity coordinator for three sessions each week, and her role was not covered when she was on annual leave or absent. Staff said that they did try to provide some extra activities, but confirmed that these were not provided in a regular or systematic way. Individual activities and residents’ response to them was not always documented. There was evidence that improved use was being made of the sensory room on Benbow House, and that assessments had been made as to the suitability of the environment for particular residents. The activity coordinator was on a six month distance learning course on activities and over half the staff had received some training on activities suitable for residents with dementia. The manager said that she was hoping to increase the activity hours on the house, and was currently recruiting for the post. Standards 13, 14 and 15 were assessed as met at the last inspection on 10th May 2005.
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18 A more open culture towards the handling of complaints is being developed, and staff have a greater understanding about the rights of the individual to be protected from harm. EVIDENCE: The home had a complaints procedure, which was prominently displayed. A relative said “if I have any concerns they are sorted out immediately”. Two complaints had been referred to the Commission since the last inspection. One concerned poor communication with relatives and defensive attitudes to complaints, which was upheld. The elements of the complaint (inspection visit on September 2005), which were upheld, concerned the management of challenging behaviour, the use of restraint, documentation of accidents, lack of activities and communication with relatives. Since the complaints considerable staff training had been put in place. There had been significant improvements in the majority of areas identified in the complaints. It was extremely positive that staff had a willingness to learn from previous mistakes, and work as a team to improve standards even further. The home had policies and procedures concerning the protection of vulnerable adults and whistle blowing. All staff on Benbow House were in the process of undertaken training in the protection of vulnerable adults (POVA). The training was also covering issues surrounding the management of challenging behaviour, the use of restraint and residents’ rights as an individual. Good systems were being put in place to review the management of residents with
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 13 challenging behaviour, and to involve a multidisciplinary team in the decision making process when necessary. The chef confirmed that kitchen staff had either completed or were in the process of completing POVA training (some kitchen staff had not had POVA training at the last inspection). Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26 Changes to the layout on Benbow House have resulted in improved supervision of residents. The refurbishment and redecoration of the lounge/dining room has provided a more pleasant environment for residents. The home is clean but odour control still needs attention in a few areas. EVIDENCE: The main communal room had been much improved since the last inspection, with redecoration, new flooring and new furniture. The reminiscence room had a number of old artefacts, and photographs of residents when they were younger. The smoking room had been swapped with the staff room. The smoking area was now in a separate room near the front entrance. The staff room was now in an area adjacent to the main communal area. Staff said that this change had resulted in improved supervision of residents in the lounge/dining area, and this was evident during the inspection. Benbow House was generally clean on the day of inspection, but there were a few areas where odour control could be improved. The head of care said that
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 15 they were currently trialling a bacteriological spray (in addition to carpet cleaning) to see whether this would help reduce odour. Staff considered that the spray was helping odour control. Standard 24 was assessed as met at the last inspection on 10th May 2005. Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The increased staffing levels in the morning have resulted in improved supervision and assistance for residents. EVIDENCE: Staffing on Benbow House had been increased from 6 to 7 staff on the morning shift. Staff considered that this was resulting in improved overall supervision of residents, and also improved assistance and supervision at mealtimes. Standard 30 was assessed as met at the last inspection on 10th May 2005, and standard 29 was assessed at the inspections of Nelson and Mountbatten Houses on 10th and 30th January 2006. Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38 Systems are in place to safeguard residents’ monies. Training in safe working practices is being given. EVIDENCE: There were clear accounts for each residents’ monies. The administrator reported that these accounts were available to residents and their representatives on request. There was a clear accounting of credits and debits, and the individual accounts were interest bearing. Services such as chiropody, hairdressing and newspapers were clearly accounted for and receipts were available. A senior financial advisor for the company carries out regular audits of the finances in the home. Staff were generally up to date in training on safe working practices, or were in the process of being trained. The senior sister was a moving and handling
Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 18 trainer. There was evidence of good systems of servicing and maintenance of equipment. No obvious hazards were noted during the inspection. Standards 31, 32 and 33 were assessed as met at the last inspection on 10th May 2005. Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(2) Requirement Timescale for action 06/02/06 2. OP8 17(1)(a) 3. OP8 17(1)(a) 4. OP9 13(2) The registered person must ensure that the care plans cover all care needs and are updated following changes in residents’ condition. Informed at the time of inspection. This has been a requirement in a previous report – timescale of 10/05/05 not met. The registered person must 06/02/06 ensure that the progress records provide sufficient details of the care given, the residents health and welfare and main occurences in the resident’s day. Informed at the time of inspection. This has been a requirement in previous reports – timescales of 10/05/05 and 1/01/06 not met. The registered person must 06/02/06 ensure that important discussions with relatives concerning residents’ health and welfare are documented. Informed at the time of inspection. This has been a requirement in a previous report – timescale of 1/01/06 not met. The registered person must 06/02/06 ensure that the receipt and
DS0000015345.V282612.R01.S.doc Version 5.1 Admirals Reach Residential & Nursing Home Page 21 5. OP12 16(2)(m) (n) 6. OP12 16(2)(m) (n) 7. OP26 23(2)(d) administration of homely remedies are accurately documented, and ensure that stocks are regularly checked for expiry dates. Informed at the time of inspection. The registered person must 01/04/06 ensure that there is a range of therapeutic activities for residents at all stages of dementia, that there are activities on a daily basis and that a record is made of individual response to activities. Informed at the time of inspection. This has been a requirement in previous reports – timescales of 10/05/05 and 01/01/06 not met. The registered person must 06/02/06 ensure that the role of the activity coordinator is covered at times of annual leave or sickness. Informed at the time of inspection. This has been a requirement in a previous report – timescale of 01/01/06 not met. The registered person must 10/02/06 ensure that the frequency of carpet cleaning is reviewed, in order to ensure that the carpets are kept clean and odour free. Informed at the time of inspection. This has been a requirement in a previous report – timescale of 01/08/05 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 22 Admirals Reach Residential & Nursing Home DS0000015345.V282612.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, 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
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