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Inspection on 07/11/06 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

Residents and relatives/visitors had only nice things to say about the staff and the way they cared for residents. Staff were very busy looking after residents during the inspection, but remained calm and cheerful and chatted with residents as best they could. All the residents and relatives spoken with, and those that sent us information in the written surveys said that they were generally satisfied with the standard of care provided at Admiral`s Reach. Residents had a good choice of food at all meals and could also choose whether to eat in the dining rooms or in their own room. Many residents said that they enjoyed the food. Visitors were welcomed. Relatives and visitors felt that the staff told them things that they needed to know about residents and how they were doing, especially if the resident wasn`t able to make decisions for themselves. Most of the healthcare workers spoken with who go to Admiral`s Reach said that the staff work well with them.

What has improved since the last inspection?

There was evidence in records that staff had given information to relatives that they needed to know about the residents and relatives` surveys confirmed this. Armchairs and bathroom floors seemed to be cleaner that that seen at the last inspection. Several staff had had training on how to protect people that might be at risk of abuse.

What the care home could do better:

To improve the services and meet the National Minimum Standards and the Regulations, attention must be paid to the list of Requirements and Recommendations at the end of this report. The main one of these, that had an effect on lots of different areas looked at in the report, is about increasing the number of staff on duty to care for residents at any time. Some parts of the premises need to be kept in better condition for residents and some things need to be made safe. Some residents said they were very disappointed with the meals served and that sometimes they were cold by the time they got to eat them.

CARE HOMES FOR OLDER PEOPLE Admirals Reach Residential & Nursing Home Ridgewell Avenue Chelmsford Essex CM1 2GA Lead Inspector Mrs Bernadette Little Unannounced Inspection 7th November 2006 08:00 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.V328329.R01.S.doc Version 5.2 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.V328329.R01.S.doc Version 5.2 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.V328329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 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 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 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 6th February 2006 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. The central services building include administration, laundry, kitchen a hairdressing facility. There is a spacious car park. The home is situated approximately one mile from Chelmsford and within walking distance of the bus service. Nelson House is registered for up to 30 residents over the age of 60 years, and including up to five residents over the age of 40 who have a physical illness/disability. All residents are Nelson House are accommodated in single bedrooms with ensuite facilities. The majority of rooms overlook the landscaped gardens. Nelson House has a dining room and four different sitting areas to meet individual needs. Mountbatten House is registered to provide care for up to 30 service users aged over 65 and those who need nursing care because of a physical disability. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 5 All residents have a single en-suite room. Mountbatten house has four communal rooms plus a dining room. The unit is surrounded by landscaped and accessible open space. Jellicoe House is registered to provide nursing care for up to 30 residents over the age of 65 years with dementia. All residents are accommodated in single bedrooms with en-suite facilities. The unit has its own lounge and dining areas. The majority of rooms overlook the gardens. 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. Benbow House has its own sensory room, a small lounge used for smoking, a quiet lounge and a large lounge dining area. The current weekly fees, dependent up on needs and facilities are Residential Care (from) £550 per week and Nursing Care (from) £700 per week. This information was provided by the registered manager. The various pre-inspection questionnaires and discussion with the home’s financial administrator advises that additional fees relate to hairdressing, chiropody, personal toiletries and newspapers. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as part of the key inspection of Admirals Reach. Two inspectors were on site from 8am to 6.30pm on the first date and one of the inspectors was on-site from 8.30am to 5.30pm on the second day. Several residents were spoken with although because of advanced dementia in some cases, not all were able to fully express their views. More detailed conversations took place with eleven residents and four visitors. Eleven staff, including care and ancillary staff, and the manager were spoken with. A tour of the individual houses was undertaken and records, including care management records, as well as policies and procedures were sampled. The commission received eleven relatives/visitors comment cards as part of the inspection process. All of these indicated that they were satisfied with the overall care provided at Admirals Reach. Discussions also took place with a GP, a visiting dentist, an occupational therapist and a continence nurse and their expressed views are reflected within the report. Written information was kindly provided during the site visit and completed pre-inspection questionnaires were subsequently received for each of the houses within the requested timescale. Information from these documents was also used to inform this report. Discussion of the inspection findings took place with the house managers and registered manager and guidance and advice was given. In addition to the above, one inspector completed an observation within Jellicoe using a methodology called SOFI. This stands for Short Observation Framework for Inspection and is designed to record an observation during the inspection of care homes where people have dementia. The observation is designed to provide a first hand experience of sitting alongside people for 1-2 hours during a regular part of the day in a communal space within the care home. The observation aims to record individual residents state of mood, an insight into who and how they interact and an insight into staff interaction with residents during this time. These observations can be used alongside other information collected during an inspection to help inspectors assess the quality of care provided. During the 1 hour observation from 11.10 a.m. to 12.10 p.m. three residents were observed over 12 five minute time frames i.e. 11.10 a.m./11.15 a.m./11.20 a.m. etc. The outcome of the observation was that out of a possible 12 occasions two residents were noted to have a positive mood state i.e. expressed signs of happiness/enjoyment and/or well-being. In the same Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 7 timeframe there were 23 occasions when all three residents were deemed passive i.e. no observable signs of positive or negative mood. There were 2 occasions when residents appeared withdrawn i.e. awake but appeared to be in their own inner world. Out of a possible 12 engagements for each resident observed, it was concerning to note that there were only 12 occasions when staff engaged with either resident. Staff interactions were task orientated i.e. taking someone to the toilet/giving someone a drink. Interactions by staff were in general observed to be adequate with few good interactions. The observation of the inspector was that care staff are very busy with tasks and are unable to spend quality time with individual residents. Residents were observed to be ignored and there were few verbal interactions/non verbal interactions i.e. words of comfort/a smile/a touch of the hand etc. Last year, each of the four houses at Admirals Reach received a separate inspection and a separate report. As the home is registered as one service, the home received one inspection on this occasion. This one inspection report incorporates aspects raised in each of the previous reports and combines all the requirements and recommendations at the end of the report. What the service does well: What has improved since the last inspection? There was evidence in records that staff had given information to relatives that they needed to know about the residents and relatives’ surveys confirmed this. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 8 Armchairs and bathroom floors seemed to be cleaner that that seen at the last inspection. Several staff had had training on how to protect people that might be at risk of abuse. 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. The summary of this inspection report can be made available in other formats on request. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 9 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.V328329.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective users of the service were provided with information to enable them to make an informed choice about the home and contracts provided information on rights and responsibilities. Pre-admission assessments needed to better show that the home has informed themselves of all the residents’ needs in a timely manner and has confirmed to the resident that they can meet these. Residents/relatives were encouraged to visit the home prior to admission to ensure its suitability for them. Intermediate care was not offered. EVIDENCE: Admirals Reach provided a statement of purpose and service user guide. The services user guide will need to be amended to reflect the changes to Regulation in September 2006. Information about the home, in the form of a brochure, is sent following all enquiries. Each of the houses had their own mission statement. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 11 Residents and relatives spoken with said they felt they had enough information about the home before they moved in. Of eight written surveys received from residents, seven felt they had had adequate information and the eighth advised that they were too unwell to be able to consider this at the time. Two residents spoken with advised that their family had accessed Commission for Social Care Inspection reports from the Internet as part of the decision-making about the home. Relatives/residents spoken with advised that a contract had been issued. Six of the eight written surveys received advised that contracts had been received; this question was unanswered on the other two. Staff advised that Admirals Reach had used a Behavioural Assessment Scale of Later Life as their pre-admission assessments tool. The Basoll assessments provided opportunity for information on aspects of the resident’s needs. Nelson House: two files were randomly sampled on this unit. A Basoll assessment was noted on both files, one had no date and the other was dated prior to the resident’s admission and had been done in hospital by the senior charge nurse. Nursing needs assessments were completed for both residents on admission. Mountbatten House: two files were randomly sampled on this unit. A Basoll assessment was noted on one file, this was undated, unsigned and the summary had not been completed. This resident had been admitted within a three month period prior to this inspection site visit. No pre-admission assessment was on file for the other resident who had been in the home for over three years. Both files contained an assessment on admission. Jellicoe House: one file was inspected on this unit for the most recently admitted resident. A Com 5 document was present from the placing authority that identified areas of the residents needs. A pre-admission assessment by Admirals Reach was not available in relation to this person, who was admitted from one of their other homes so that the person could be nearer to their family. Benbow House: two files were randomly sampled on this unit. Both files contained a Basoll assessment, one of which was not dated. Both files contained an assessment on admission. The last inspection report of Nelson house indicates that a resident was accommodated for whom the house does not have appropriate registration. This remains outstanding although staff advised that this is being actioned, assessments had been undertaken as part of a planned move. The staff training matrix indicated that staff on Benbow, while the majority had training on dementia, did not have training on the management of behaviour Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 12 that challenges. The matrix indicated that on Jellicoe, the majority of staff have not had training on dementia care or positive responses to challenging behaviour, although both Benbow and Jellicoe houses are registered to care for people who have dementia. Other information on training needs is identified in the section on staffing later in this report. Residents and relatives spoken with said that there had been opportunity to visit the home prior to admission and several residents said that they/their family had taken this up. Admirals Reach did not offer intermediate care. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident had a care plan that was supported by risk assessments. Development of these to cover all aspects of resident need would show better evidence of consistent care. Residents’ health care needs were met. Medication systems did not best protect residents. EVIDENCE: Nelson House: two care plans were tracked fully on this unit and others sampled for various issues. Both contained a life map and an outing/activity questionnaire. Information in care plans referred to maintaining residents choice, dignity, privacy as well as independence skills, which is positive. There was evidence that relatives had been involved/advised of the care plans and this is good practice. The care plans covered a number of areas of identified need. There were clear instructions for staff in some areas, although this was lacking in others for Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 14 example, clarity as to which incontinence pad was to be used for the particular resident. These were reviewed monthly and demonstrated that staff were aware of some information that should have been contained within the plan of care. Plans were supported by appropriate assessment tools, for example in relation to nutrition, continence, tissue viability and moving and handling. Individual risk assessments had been undertaken in relation to for example, use of a wheelchair, going out, or the use of bed rails. For one resident the care plan and risk assessment advised that covers were to be used on the bed rails to prevent injury. On visiting this resident in their room, the bedrails were in place, but without protected covers. The senior nurse in charge of the unit advised that they were short of protective covers but that they had ordered some more yesterday. This is not good practice and should have been managed more effectively to protect the resident. It was noted positively that one resident’s file contained a signed agreement for self-medication of pain relieving tablets, including an agreement to keep them in a locked drawer. There was no clear care plan or risk assessment for the resident (including the potential risk for other residents) in relation to medication. Mountbatten House: care files were tracked for two residents on this unit. One did not contain a photograph of the resident who had been at the home for almost three months. The care plans covered a number of areas of resident need including for example nutrition/diabetes with good detail, social care needs and residents choice of keeping the bedroom door open. While risk assessed, this raises a concern as the door is not fitted with an automatic closure in the event of fire and senior staff were made aware. Risk assessment was in place relating to for example falls, wandering, nutrition, and tissue viability. These were reviewed monthly along with the resident weight, dependency rating score etc. One file showed an assessment relating to pressure relief that identified a high risk, but no care plan was found on the file to support this. Jellicoe House: three care plans were tracked on this unit. They contained life histories completed to better or lesser degrees. Care plans were in place for all residents sampled and some good detail was identified. However in relation for example to challenging behaviour it did not identify specific known triggers or how resistant behaviour was to be managed safely and effectively. With relation to a resident’s dementia there was no information regarding communication, mental health/well-being, activities, dietary requirements or a medication plan. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 15 Risk assessments were in place as identified previously on other units and it was noted that moving and handling assessments were clear on all units. However on this unit there was no individual risk assessment for example relating to diabetes or challenging behaviour, were these were pertinent issues. Benbow House: there were 29 residents living on this unit at the time of the site visit and two care plans were tracked. They contained the same format for risk assessments for example in relation to nutrition, falls, moving and handling and with monthly reviews. There were several aims in the care plans and some of them contained detailed information on the care to be given. In other areas there was a lack of clarity that would ensure consistency of care, for example in relation to oral care, and these were discussed with the senior staff on duty. All instances of moving and handling/transfers observed during the site visits indicated that staff had knowledge of protecting both residents and themselves, and used good procedures in practice. Care notes were available on all units and were written as a minimum once during the day and once at night on files sampled. They were generally written more often than this and contained relevant information. Care plans on all units needed to include all aspects of the resident’s health and welfare including those identified in this report and for example oral care, foot care and medication. There was evidence that care plans had been updated to reflect changes in residents’ needs. A view was expressed that wheelchairs and cushions are not always clean and that residents are not always using the appropriate equipment provided. All files indicated that bed rails were to be checked regularly, they did not determine what regularly meant and there was no record to confirm that this had occurred. The eleven relatives/visitors comment cards received all stated that they felt they were kept informed of important matters affecting their relative/friend and where appropriate, were consulted about their care if the person was not able to make decisions. Healthcare notes indicate that residents regularly have access to primary health care services such as the GP, chiropodist and dentist. Some residents have retained their own GP as they were within the area. All residents were registered with the local practice and one or other of the GPs visits the units on a weekly basis. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 16 Discussions with healthcare professionals during the site visits indicated that they viewed that there was appropriate care provided at Admirals Reach. One comment was “ the care is very good on the units and I take my hat off to the staff on the EMI units”. Most professionals were clear that staff were aware of residents’ needs and called in their assistance appropriately. There was a majority view that staff worked with the professionals and communicated appropriately. It was identified that staff do not escort residents when attending the assessment clinic when they would have important information to support the assessment. The air-conditioning unit in the medication room on Nelson House was broken and was advised as having been so for months. While this was not raising an issue while temperatures outside were so very cold currently, it clearly needed to be attended to. Medication was tracked for two residents on Nelson House. Medication Administration Recording sheets were well maintained and photographs of each resident was available. Eye drops were stored in the fridge and had a recorded start date. Blister packs tallied with the MAR sheets. Controlled drug medication records and medication was sampled for another resident and was appropriately maintained. Information on one resident’s change of medication has not been appropriately recorded. Protocols were not in place in relation to ‘as required’ medications. Medication was not assessed on Mountbatten House on this occasion. It was noted however that a resident had been left their tablets in a medication pot in their bedroom without the staff member observing whether the resident actually took the medication. Medication was observed as administered appropriately on Jellicoe House, with the exception that the medication trolley was left unattended on a couple of occasions, with the door open and medication easily accessible. This is a potential risk. On inspection of the units Medication Administration Records these were observed to be satisfactory with no omissions. Where `O` was recorded on the MAR sheet, staff must record the reason for this. A list of the signatures/initials/names of staff deemed competent to administer medication was available. A resident Identification Sheet was evident for all residents and included a photograph. Medication on Benbow House was observed in the early evening and was administered to residents at 5.15 p.m. as residents were having tea. Administration of the medication was observed to be satisfactory, however there were occasions when the staff had to leave the trolley unattended as they were needed to attend/pay attention to residents who wanted to monopolise their time. No omissions were noted on the MAR sheets. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 17 Residents spoken with and able to express a view said that they felt their dignity and privacy was respected by staff. As noted previously, care plans identified and supported privacy and dignity for residents. Care staff spoken with demonstrated an awareness of this issue and one confirmed it had been a major part of their induction. Care plans in relation to death and dying were noted on the files sampled. Some of these contained good detail and clear instructions while others spoke in general terms of what could happen and did not provide clear information. A staff member was positively noted to spend time with a bereaved family, despite all the other pressures. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Aspects of the lifestyle at the home, for example social and mental stimulation, met the needs of some residents better than others. Visitors were welcomed. Some residents were offered choice and encouraged to make everyday decisions. Residents were provided with a varied diet that was enjoyed by some and not by others. EVIDENCE: Activity coordinators are employed on the houses for various hours each week. The activities person advised for example that activities on Jellicoe House are available Tuesday, Wednesday and Fridays for 2 hours in the morning and 2 hours in the afternoon. The inspector was advised that activities this week were not available in the afternoons as there was no activities co-ordinator. A timetable is displayed in the main reception area and this also details special events provided. A weekly record of planned activities was displayed on the houses. A record is kept on individual files of the activities participated in by each resident. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 19 These included for example hand massage, 1-1 conversations, external entertainers, seated exercises, bingo, throwing the ball, painted nails etc. Activity staff were observed to be offering a bingo game on Benbow House. One resident said they enjoyed the church services held in the home. Another resident’s care plan/care records confirmed that family collect the resident on Sunday to take them to a service of their own faith. For a less able resident the activity records show that they were brought to the lounge to listen to the music and that the activity coordinator visited the resident in their own room for a chat. Care plans and care records sampled indicate that a limited number of residents do have opportunity to go into the community, for example to an exercise class or a craft club, and they are usually taken by relatives/friends. Activity coordinators took some residents for a walk. Of the eight residents surveys received, three residents stated they felt there were always activities arranged by the home they can take part in, three residents said there are usually such activities and two residents felt that there are only sometimes activities they can join in with. Individual residents praised the activity coordinators, “she is marvellous”, but also expressed views such as “it would be nice to have a wider range of activities, not just keep fit and cooking”. Observations at a site visit and discussions with staff indicated that there are occasions when activity coordinator staff were not available for the limited planned hours allocated. It was clear from the observations on the houses that while nursing/care staff did speak and interact with residents this was task orientated, they did not have adequate time to give to providing for the emotional, mental and social stimulation care needs of the residents. Residents able to express a view confirmed that they do exercise some control over their daily lives and make decisions. This related for example to when to get up or go to bed, what to eat and where to eat, whether or not to join in a activities, what to wear and whether to spend time in their own room or in the communal rooms. Instances were observed where staff encouraged less able residents to make a choice, for example some people were asked whether they would like to wear an apron during their meal, where others were not, staff spoke to residents by name, asking them if they would like to sit in a particular place or if they would like another cup of tea. All eleven comment cards from relatives/visitors stated that they felt welcome in the home at any time and could visit their friend/relative in private if they wished. All relatives spoken with across the houses said they felt welcome. All Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 20 residents spoken with also said that they felt their visitors were always welcomed. Staff on Benbow house for example, stated that family are very welcome to be involved and eat with residents and staff feel that they are a help to the unit. There was a wide variety of comments regarding food, both in discussions at the site visits and as comments in the resident surveys received by the commission. Many felt that the food was very nice and that they were offered plenty of choice. Many others expressed dissatisfaction for example that the food was often cold when it was served to them or that there was a lack of choice or poor planning in the menu, for example chicken pie for dinner followed by apple pie for desert. The days menu was not clearly displayed on any of the units. Residents spoken with and able to express a view advised that they were provided with regular drinks throughout the day, both hot and cold. Residents also said that they could choose to eat in their rooms if that was their preference. Observation of practice over the units indicated that staff did encourage and assist residents to take their drinks where they needed this additional support. On occasions however it was clear that the hot drinks were cold by the time the staff member was able to have time to assist that person. Staff were observed to walk around with some residents, at the residents pace, to encourage them to take fluids Breakfast was seen being served from 8.15am through to 10.30am on different units. There was a choice of cereals and cooked breakfast and the choices of menu were confirmed in the menu and nutrition records. Part of the breakfast meal and the lunchtime meal were observed on Nelson House. Tables were set attractively on both occasions. Some staff were sitting with residents to feed them while other staff were administering medication and serving the meal from the heated trolley. Many residents have delayed swallows and nine people were stated to need feeding while others need their food cut up for them. Particularly at breakfast it was observed that there were periods of times while, although a staff member may be close by or in the satellite kitchen, there was no staff with the residents. Both nursing and care staff on the units advised that it is very pressured to provide residents with appropriate care and attention and one described it as ‘manic without seven staff on duty’. The lunchtime meal was observed on Mountbatten House. Tables were set with cloths, place mats, continents, glasses, and napkins. Residents were offered a choice from a tray of juices. One staff member was serving the meals from a heated trolley that was brought to the units from the main kitchen, while other staff brought it to the tables. One staff was sitting with residents to feed them, Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 21 while talking to them and explaining what they were having. Another staff member was administering medication. The buzzers were heard to be ringing. Staff advised that this was from residents who ate in their room and were waiting for their food. Some of the residents who eat in their room were advised as needing at least observing, if not supervision. Staff confirmed that lunchtime is extremely pressured in terms of staffing if there are only four staff on duty and this is even more so at breakfast time, also taking into account for example that the phone may be ringing and the GP may be on-site. A resident was heard to say that the food was ‘lovely and hot’. Liquidised foods were well presented with each item separately liquidised. The breakfast and lunchtime meals were observed on Jellicoe House. Breakfast was started at 8.20am and was continuing at 10.20am. There was a clear choice of menu at both meals. One carer served breakfast and was also the only person providing assistance to individual residents. The carer was observed to provide appropriate support, for example sitting down to feed residents, with some initial good interaction for example “ good morning and how are you” and “ would you like some breakfast”. However there was no verbal interaction after that and actual assistance appeared somewhat hurried/rushed in some cases. There was a limited choice of drinks at lunchtime and while a second variety was found, only one resident was offered an actual choice. The lunchtime meal delivery was observed to be hectic and it is clear that the unit could benefit from an additional member of staff. At least one third of residents within the unit require feeding and/or a lot of verbal prompting. Some residents were asked if they wished to wear an apron whilst for others it was just assumed. Pureed food was given to those residents who require a soft diet. One resident did not want either of the options on the menu and staff ordered what the resident wanted. The evening meal was observed on Benbow House. Tables were set with cloths and matching crockery. One staff was serving the food while a senior was endeavouring to administer medication. All staff were trying to interact with residents and were sitting to feed them but it was seen to be an extremely busy time with residents wandering off without eating or waiting for periods of time until a staff member was free to feed/assist/encourage them to eat and drink. Staff remained calm and patient and interacted positively with residents while undertaking these tasks. The teatime meal was not rushed and lasted until 6pm. Staff were observed to assist/feed residents sensitively and with due care. One carer was particularly noted to interact verbally with residents and to provide good eye contact when assisting individuals. Residents were given a choice of assorted sandwiches, hot dogs, soup and some had a pureed meal. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s approach and systems supported residents and relatives to express their views and there was evidence that these were listened to and actioned. Staff were confident to raise concerns to protect residents. The home’s response protected residents when a concern was raised. Training for all staff would better safeguard residents. EVIDENCE: BUPA has a comprehensive complaints procedure with clear timescales for action. The information on the procedure displayed in the main administration building needs to be amended to reflect accurate information for contacting the commission for social care inspection and to clarify that the commission does not investigate individual complaints. Of the eight written surveys received from residents five said they usually know how to make a complaint three said they would always know. Of eleven relative/visitor comment cards received all but one stated that they were aware of the homes complaints procedure. Complaints are managed centrally. Leaflets were readily available that explained clearly how to make a complaint and had space for the person to Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 23 record the details. The registered manager provided evidence of recent complaints, which logged the date they were received, their individual number and the date they were completed. Two related for example to lost laundry (one of which the resident later agreed had been due to confusion on the number of sheets in a set), not enough fruit in bowls on the units, the cauliflower cheese not having enough cheese and an odour on a unit. Each had been considered and responded to appropriately. A more formal complaint has recently been made by a relative in relation to the protection of vulnerable adults (POVA) issue noted below. This is currently being investigated by BUPA. Eight compliments were logged in this year. Comments included “ I have nothing but praise for the staff” “ will never forget the respect shown to (relative)” “ thank you for the excellent care” and “ have nothing but the highest opinion of staff”. Of the eight written surveys received from residents six said they would usually know who to speak to if they were not happy and two said they would always know who to speak to. Admirals Reach had policies and procedures concerning the protection of vulnerable adults (POVA) and whistleblowing. Following the last inspection the registered manager notified the commission of a referral made under POVA. The home followed all correct procedures and following investigation/involvement of the family and other appropriate professionals the issue was not pursued. A further recent notification from Admirals Reach informed the commission that another incident had been reported under POVA and related to two residents. The incident was reported by a member of staff had clearly operated whistleblowing. The home reported the matter to social services under the POVA guidelines, called the GP and the police and reported it to the commission as required. The investigation remains ongoing, and the home has dismissed a member of staff. Staff spoken with on various units confirmed that they had had training on the protection of vulnerable adults. They were able to identify types of abuse and generally were clear that they would take appropriate action should they have any concerns. A training matrix identified that despite a training session in February 2006, there remains some qualified, care, and ancillary staff, who are recorded as not having received protection of vulnerable adult training at all and others who have not had training since January 2005. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had comfortable and accessible indoor and outdoor space. The standard of homeliness for residents varied in their individual bedrooms. Cleanliness and maintenance issues needed attention in some areas to provide residents with a safe and pleasant living environment. EVIDENCE: The four units were identical in layout and all areas were accessible to wheelchair users. There is a large open plan lounge and dining area on each unit, a satellite kitchen, a small lounge used as a quiet/visitors room and an office (see Benbow). All bedrooms were single and ensuite. There were assisted bathrooms on each corridor and with separate additional toilets, including close to the communal areas. The gardens were well maintained. The home also has its own hairdressing facility for residents use. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 25 The section on care plans refers to the outstanding issue of a resident’s bedroom door being left open at night to meet their specific need and preference. The door continues not to be fitted with an automatic closure in the event of fire and so presents a potential hazard to residents and staff. The dishwashers were not working in most of the units, and had been out of action for some time. This resulted in staff having to spend time on these tasks, which took them away from caring for residents. All residents spoken with were satisfied with the laundry services and positive comments were made relating to this issue in a resident’s questionnaire that was received by the commission. The section on complaints however identifies that they have been some issues relating to the laundry service. The registered manager advised that as the home is now 10 years old new equipment is planned for the laundry in the next budget. Bedroom doors locked as they closed, as a resident left the room. Residents spoken with on Nelson House did not have a key and explained that only staff had the key. While this may be appropriate on some houses/for some residents, in all cases it should be risk assessed and documented in each resident’s care plan. Staff spoken with confirmed that they had adequate equipment for residents, for example hoists, and corridors were fitted with handrails. Nelson House was generally well maintained in terms of décor. Two residents spoken with said they were happy with their rooms and one had their own telephone installed. In the satellite kitchen, the wooden cupboards were dirty as were the lids of containers, for example for tea and sugar. Trays of cooked eggs and sausages/bacon were left uncovered on top of a microwave while continuing to be served to residents. The bath panel was broken in both bathrooms. The toilet seat was broken off in one bathroom. The separate toilet identified as number 40, had a broken mirror that was taped with selotape and presented sharp edges, and neither of the taps in the wash hand basin were in working order. These issues were not recorded in the maintenance book and were made known to senior staff for appropriate and timely action. It was also noted on this unit that while bedrooms were personalised to varying degrees, all of them have vinyl type flooring, which does not present as homely. There was no clear risk assessment or reason noted for this for each or any resident. In later discussions with the registered manager, she Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 26 confirmed that they will be considering the fitting of carpeting for some residents where this is individually appropriate/preferred. Mountbatten House: seven residents were spoken with on this house and all said that they were satisfied with their rooms and the communal areas, which were generally well maintained. A resident spoken to on this house said they did not want a key to their room. New carpet had been fitted in the lounge area. It was noted that the small, quiet lounge had been redecorated to look like an individual sitting room with a sewing machine, fireplace, pictures etc. The clock in this room was not set to the correct time. The sluice room was unlocked and there was some odour. Temperatures sampled in bathrooms were satisfactory and radiators were fitted with thermostatically controlled valves. The curtain inside the bathroom door that allows privacy for residents was falling off its hooks. For one resident who spent most of their time in bed, the wall beside their bed was stained by what looked to be tea or food. Jellicoe House: a basic inspection of the premises on this house and the areas sampled indicated that there were no odours or potential hazards. Benbow House: The office in the Benbow had been moved to being a small area within the lounge, with clear vision panels. This assisted staff to continue to observe residents while undertaking routine recording or telephone answering tasks. One room had an offensive odour. Conversely to the issue on Nelson, a relative advised that they had requested that the flooring be changed to something more appropriate to a person who had continence management/behavioural issues. Advice on the need to assess this individually for residents was given both to the relative, the staff in charge of the unit and the registered manager. It was positive to note that the flooring had been changed by the time of the second site visit. The smaller lounge was in very poor decorative condition where the walls were marked and for example the doorway tread to restrict the carpet was missing and the concrete was showing. The other lounge was used as a smoking room and had a call box phone on a trolley for resident use. No call bell was fitted. Staff advised that a big clock had been given to one resident for their room as part of a conditioning programme. This resident has been provided with the key to their room which staff feel is very important to the person. Staff advised that the family/residents can choose the colour of the room if it has been empty prior to their admission, and that residents are encouraged to bring their own furniture etc. to maintain orientation and familiarity. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 27 There was clear signage for residents on the bathroom and toilet doors. This was not well presented on individual bedroom doors to help residents with orientation. The bathwater was noted to be cool and when tested actually only reached 25°C. It was later advised that there has been a problem with a boiler. This water temperature was not sufficient for any resident to be bathed and it was confirmed that this was being addressed. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents felt that staff worked hard and listened to them. Staffing levels were not adequate to meet resident need and to provide a good quality of life for some residents. The home has an NVQ training programme for staff. The homes recruitment procedure safeguarded residents. EVIDENCE: All resident and relative comments regarding the staff were positive for example “ the staff are very nice”. Copies of rosters were requested and provided as part of the inspection process. It was clearly observed throughout the site visits that staffing levels, in comparison to the dependency levels of the residents, were not adequate to meet residents’ needs. This was confirmed by some residents and relatives as well as by the staff. Evidence of how this affected residents and the quality of the care that staff can provide for them is indicated in the various sections throughout this report. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 29 Inspection of 5 weeks staff rosters on Jellicoe for example identified that since the last inspection, staffing levels have reduced from 7 to 6 staff on the morning shift and from 6 to 5 staff on the afternoon shift. A similar reduction was noted on Benbow House. Staff deployment within the home is poor as a result of a reduction in the staffing levels and not as a result of any observed lack of effort by staff. There were periods of time when the lounges were not under the supervision of staff and residents did not receive appropriate interactions from staff. Staff appeared to have a staggered break and have their drink/meal in the homes dining area. Residents on Benbow were advised as, and noted as, having more functional type dementia, which meant they were more active. Records showed that there were a high level of accidents for residents on Benbow. Staff said they used up probably one accident book per month and that there were so many near misses. From discussion with some relatives, comments were made specifically in relation to Benbow’s staffing levels and some observed that they did not feel there were sufficient staff working within the home to meet residents needs. One relative advised that they felt there was a distinct lack of stimulus for individual residents. Similar reductions in staffing were noted on the other units and had an equally negative effect on residents and staff. Of the 11 relatives/visitors comment cards received four stated that they did not feel there were always sufficient numbers of staff on duty, one stated they didnt know and six stated they felt there were always sufficient staff numbers on duty. Seven resident questionnaires said that staff listen and act on what they say, while one said they usually do but they seem short of staff and are very rushed. Two surveys indicated that staff were always available to residents when needed, five felt they were usually available and one that they were sometimes available when needed. One comment stated “need more staff”. The registered manager advised that ten of the care staff had completed NVQ2 and three staff had completed NVQ3. Eight staff have left who had completed NVQ3 on the program and seventeen care staff are currently undertaking the training. Staff recruitment records were held centrally and securely stored. Files for two recently recruited staff were randomly sampled. Both of these contained an application, a declaration of offences and fitness in relation to health, photographs, a statement of terms and conditions and a job description. Both files also contained appropriate references and criminal record bureau checks in place prior to employment commencing, and evidence of identity. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 30 Both files sampled contained a probation review at the end of the first threemonth period. For one, this had occurred some four months previously, and the other very recently occurred and identified the staff member must enrol on a course to improve their English language skills. For this latter staff member there was no evidence of any induction or training on file, except for a Personal Best certificate. On the file for other member of staff there was evidence of safe moving and handling, food hygiene, fire training, basic health and safety and a Personal Best course. The registered manager advised that a workbook/folder for Skills for Care induction was used, but due to a technical hitch copies of the back page of each section had not been retained for the staff member’s file but that these are now being gathered. One staff member spoken with had been in post for two years and advised she had renewed her contract as she enjoys her work at Admirals Reach. The staff member advised of a good TOPSS induction, with initial training on moving and handling, fire, pova etc. She also confirmed that consideration in relation to the privacy and dignity of residents was a big part of her induction training and everyday practice. Copies of training matrices were kindly provided. These were difficult to read as they continued to contain the names of many staff who appear to have left the home. While medication training was recorded training for some houses, it was not included on others. There was no evidence provided of recent medication training or updates. There had been training for staff this year in for example fire, food hygiene, load management and promotion of continence. Some staff had no record of food hygiene or infection control training for example and other staff needed updates on mandatory basic issues such as load management. The matrix indicated that one third of the staff on Jellicoe had not attended basic dementia training, and none had had training on positive responses/ management of behaviour that challenges, though one staff had attended training on managing violence or aggression in the workplace. Most staff on Benbow House are recorded as having had training on dementia, but not on positive responses/ management of behaviour that challenges. Six staff on Mountbatten and two staff on Nelson had attended training on communication in 2003. One staff on Mountbatten had training on promotion of continence in 2004 and another staff had training on pressure area prevention care the same year. Eighteen staff on Nelson House had had training on promotion of continence this year. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 31 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes manager is qualified and experienced. Systems in the home were generally well organised. The lack of timely action by the registered manager in relation to staff advice on the need for increased staffing levels to meet resident need is of concern. The home has a quality assurance programme with systems in place to regularly monitor the quality of the care and services provided for residents. Systems were in place to safeguard residents’ money. While the safety and welfare of people at the home were generally protected this may be improved by more appropriate staffing levels and better maintenance of equipment. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 32 EVIDENCE: The registered manager has been in post for some years. In addition to being a qualified nurse, she also has a diploma in management. She advised of more recent training in relation to Pursuit of Excellence and a four-day course on Dementia Care. The registered manager confirmed that she was provided with regular supervision by her line manager. Each of the houses is run by a Charge Nurse who reports to the registered manager. Staff spoken with said that the manager is approachable and that they had been able to go to her to request additional staffing levels were reintroduced on the units. The manager confirmed that staff had approached her with this issue but advised that she had budgetary constraints to manage and was going through the various channels to address this. There must be appropriately trained staff and staffing levels/deployment in place to meet the needs of residents. As well as a quarterly self audit on all aspects of the service provided by Admirals Reach, the registered manager advised that BUPA undertook a satisfaction survey that included both a general one and one designed for the dementia care units. The outcome of this will be sent in a report via a management directive, but this has not yet been returned for this year. Other systems were also in place in relation to for example health and safety audits or audit of accident records. This could have been used as an indicator to support the case for increased staffing levels for example in Benbow House. Residents meetings were stated to have occurred three monthly previously but that attendance had been so poor they had only had one this past year. Visits required to be undertaken monthly by Regulation 26 were evidenced as having occurred regularly through the availability of the reports. Rosters needed to contain the full name of all staff working in the care home. The home managed money for a number of residents. The financial administrator advised that relatives bring money in which is paid into the residents account. From this the financial administrator pays for items such as hairdressing and chiropody, and for some residents for newspapers. A reminder is then sent to the family when a top up for the account is needed. The system allowed an individual statement to be produced for an individual resident and receipts were maintained. This evidenced interest paid and payments for the advised items. The inspection labels on the Arjo bath hoists indicated that they should have been re-inspected again sometime before this site visit. The maintenance man and the manager advised that they have an agreement/maintenance Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 33 procedure with the company that allows the home to have responsibility for the safety of these hoists by the other part of the year. Areas sampled relating to health and safety included evidence of a current electrical fixed wiring certificate, and gas safety certificate, a record of weekly tests of the fire alarm, and a certificate for the emergency lighting and fire alarm system for each of the units. COSHH items (Control of Substances Hazardous to Health) were stored safely. Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 34 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 2 3 2 1 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 2 3 2 2 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 3 X 2 2 Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 35 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 OP1 Regulation 5 Requirement The service user guide must be amended to reflect the changes in regulation (September 2006) and include the required information. Timescale for action 01/03/07 2 OP3 14(1)d The registered person must not 01/01/07 to provide accommodation to a service user until they have obtained a full assessment of the person’s needs and ensured that they have confirmed in writing to the service user, that having regard to the assessment, the care home is suitable to meet the residents needs in respect of their health and welfare. The person registered must ensure that all care staff at the care home must undertake appropriate training to the work they perform and have the necessary skills and expertise to meet the specialist needs of service users. This refers for example to staff having training in dementia care and positive responses to managing DS0000015345.V328329.R01.S.doc 3. OP4 18(1)c 01/04/07 Admirals Reach Residential & Nursing Home Version 5.2 Page 36 4. OP4 4(3)(b) behaviour that challenges. The registered person must ensure that the home only offers care within the category for which they are registered. This relates to the resident with a mental illness currently in Nelson house who must be found a more appropriate placement. This is a repeat requirement from two previous inspections. Previous timescale of 31/03/06 not met. The registered person must ensure that the care plans cover all care needs including those identified in this report, for example pressure area care. This has been a requirement in previous reports - timescales of 10/05/05 and 06/02/06 not met. 01/04/07 5. OP7 15(1 & 2) 01/03/07 6. OP8 13(4)c The person registered must ensure that any unnecessary risks to the health and wellbeing of service uses are identified and as far as possible eliminated. This refers to risk assessments for such issues as diabetes, the use of bedrails without protective covers, or challenging behaviour. The person registered must ensure that staff support residents to use assessed/available equipment. The registered person registered must ensure that all aspects of resident health care is included in their care plan for example, oral care, foot care or medication. The registered person must DS0000015345.V328329.R01.S.doc 01/03/07 7. OP8 23(2)n 12(1)a 01/12/06 8. OP8 12(1)a 15(1 & 2) 01/03/07 9. OP9 13(2) 21/11/06 Version 5.2 Page 37 Admirals Reach Residential & Nursing Home ensure that the receipt and administration of homely remedies are accurately documented, and ensure that stocks are regularly checked for expiry dates. Not inspected on this occasion, carried forward to a future inspection. 10. OP9 13(2) 13(4) The person registered must ensure that a risk assessment is available for each resident in relation to self-medication and this is then linked to an individual care plan. The person registered must ensure safe recording, storage, handling and administration of medication. This includes all issues raised in the report, including the accurate recording of the current medication to be administered, medications being observed to be taken before being signed for as administered and safe supervision of the medication trolley. The registered manager must ensure that there are appropriate numbers of staff working at the home to support individual service users with their personal care needs. Outstanding from the previous inspection report of 03/01/2006. The registered person must ensure that there is a range of therapeutic activities for all residents, including those at all stages of dementia, that there are activities on a daily basis. This has in part been a DS0000015345.V328329.R01.S.doc 01/03/07 11. OP9 13(2) 21/11/07 12. OP10 18(1)a 21/11/06 13. OP12 16(2)(m)( n) 21/11/06 Admirals Reach Residential & Nursing Home Version 5.2 Page 38 requirement in previous reports timescales of 10/05/05 and 01/01/06 and 01/04/06 not met. 14. OP12 16(2)(m)( n) The registered person must ensure that the role of the activity coordinator is covered at times of annual leave or sickness. This has been a requirement in previous reports – timescales from 05/07/05 not met. 15. OP14 OP33 12(2) & 16(n) & 24 The registered person must conduct the home in a way that maximises service users abilities to exercise choice and make decisions. This refers to providing residents with the support and opportunity to attend residents meetings. The registered person must ensure that food is served to residents at an appropriate temperature and that there are adequate staffing levels to enable this to occur. The registered person must ensure that the complaints procedure contains accurate information in all documents. The registered person must ensure that all staff receive protection of vulnerable adults training. (Previous timescales of 01/04/06 not met. The registered person must ensure that all areas of the premises are kept in a good state of repair. This refers to the issue identified in the report DS0000015345.V328329.R01.S.doc 21/11/06 01/03/07 16. OP15 16(2)i & 18 01/03/07 17. OP16 22 01/03/07 18. OP18 13(6) 01/04/07 19. OP19 23(4)a, b, c 21/11/06 Admirals Reach Residential & Nursing Home Version 5.2 Page 39 20. OP19 23(2)b regarding the fire door. The registered person must ensure that all areas of the premises are kept in a good state of repair. This refers to the issues identified in the report for example the broken mirror, bath panels and toilet seat. The registered person must ensure that all equipment on the premises is kept in a good state of repair. This refers to the broken dishwashers. 21/11/06 21. OP19 23(2)c 21/11/06 22. OP19 23(2)d The registered person must 21/11/06 ensure that all areas of the premises are kept clean and reasonable decorated. This refers to the issues identified in the report, for example the cleanliness of the satellite kitchen, the dirty wall in the resident’s bedroom and the poor décor in the small lounge. The sluice room doors must be kept locked to safeguard residents. The registered person must ensure that residents have access to appropriately hot bath water in each of the houses. The registered person must ensure that each resident’s bedroom is fitted with a floor covering appropriate to their individual needs. The registered person must ensure that the home is maintained free from offensive odours. The registered person must ensure that staffing levels are DS0000015345.V328329.R01.S.doc 23. OP19 13(4) 21/11/06 24. OP21 23(2)j 21/11/06 25. OP23 16(2)c 01/01/07 26. OP26 16(2)k 01/04/07 27. OP27 18(1)a 21/11/06 Page 40 Admirals Reach Residential & Nursing Home Version 5.2 increased on the individual houses and the previously identified levels re-instated to an adequate level to meet resident need. 28. OP30 18(1) a&c The registered person must ensure that all staff are provided with training appropriate to the work they do. This includes evidence of induction training, as well as basic, mandatory training and updates and training appropriate to the needs and conditions of the residents that the home provides care for. The registered manager must ensure that there are adequate staffing levels on each of the units and act in a timely manner to information provided by staff in relation to this and any other matter that effects the wellbeing of residents. 01/04/07 29. OP31 9 21/11/07 30. OP37 17(2)Sch4 The rosters must contain the full (8) name of all staff working at the home. 17(1)a Sch 3 (2) A photograph must be available of all residents. 01/01/07 31. OP37 01/01/07 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 OP4 Good Practice Recommendations Clear signs should be available in all areas of the home relevant to the needs of residents, for example on resident bedroom doors and these should of a reasonable quality DS0000015345.V328329.R01.S.doc Version 5.2 Page 41 Admirals Reach Residential & Nursing Home and well maintained. 2. OP11 All care plans should contain clear information on the planned actions and resident’s/relatives’ wishes regarding end of life care. Action should be taken in a timely to ensure that the temperature can be managed effectively at all times in the medication room Protocols should be in place for each resident’s ‘as required’ medications. The system for keeping hot food on the satellite kitchen should be reviewed in terms of effectiveness and safety. The person registered should re-introduce resident meetings as a forum to enable individual to express their personal preferences relating specifically to their diet. Outstanding from the previous inspection report of 03/01/2006. Maintenance reporting/records should be available and they should used effectively by staff on all houses. Evidenced risk assessment should available on all residents file to demonstrate why they do/do not have a key to their room, including the residents individual views. 50 of care staff should achieve NVQ2 in care. 3 . 4. 5. 6. OP9 OP9 OP15 OP15 7. 8. 9. OP19 OP24 OP28 Admirals Reach Residential & Nursing Home DS0000015345.V328329.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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