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Inspection on 09/07/08 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

The home environment is well maintained and decorated to a good standard and provides people with a homely, comfortable and safe place in which to live. Residents are supported to maintain contact with family and friends. Visitors to the home are made to feel welcome, and some staff, were observed to have a good rapport with residents. Residents feel able and comfortable to raise concerns or queries with staff and generally feel confident that they will be listened to. There is an appropriate formal assessment process in place for prospective residents wishing to be admitted to Admirals Reach. No people are admitted to the care home, without an assessment having been undertaken.

What has improved since the last inspection?

There is a vigorous recruitment process in place, which ensures that staff recruited to Admirals Reach, are suitable, that all necessary checks as required by regulation are undertaken and people living in the home are safeguarded. Meals provided to residents are now served at the appropriate temperature and a choice of vegetables is available which reflects resident`s personal preferences and choice.

CARE HOMES FOR OLDER PEOPLE Admirals Reach Residential & Nursing Home Ridgewell Avenue Chelmsford Essex CM1 2GA Lead Inspector Michelle Love Unannounced Inspection 9th July 2008 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.V367616.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.V367616.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 chitambc@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Mrs Chipema Chitambala Care Home 128 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.V367616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N. to service users of the following gender: Either. whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. Physical disability - Code PD. The maximum number of service users who can be accommodated is: 128 27th September 2007 2. 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. 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 Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 5 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. Additional fees relate to hairdressing, chiropody, personal toiletries and newspapers. The home has a statement of purpose and service users guide available. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection. The visit took place over two days and by two inspectors and lasted a total of 13.5 hours, with all but one of the key standards inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises within each of the 4 houses was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the inspection surveys were forwarded from us to the home for distribution to residents next of kin, healthcare professionals and staff who work within the care home. Where surveys have been returned to us, comments recorded have been incorporated into the main text of the report. The manager, house manager’s and other members of the staff team assisted both inspectors on the day of the inspection. Feedback on the inspection findings, were given on both days with the person in charge on each house and the registered manager. The opportunity for discussion and/or clarification was given. What the service does well: The home environment is well maintained and decorated to a good standard and provides people with a homely, comfortable and safe place in which to live. Residents are supported to maintain contact with family and friends. Visitors to the home are made to feel welcome, and some staff, were observed to have a good rapport with residents. Residents feel able and comfortable to raise concerns or queries with staff and generally feel confident that they will be listened to. There is an appropriate formal assessment process in place for prospective residents wishing to be admitted to Admirals Reach. No people are admitted to the care home, without an assessment having been undertaken. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Further development is required in relation to the care planning and risk assessing processes so as to ensure that individual plans of care are comprehensive, up to date and reflective of people’s current care needs. Ensure that where people require assistance and encouragement to eat their meal, appropriate support is provided by care staff. Some staff in the home do not always treat people with respect and care and were observed paying little attention to the people in their care. Some members of staff did not appear to understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact this has if not carried out. Interaction between some staff and people living in the home was seen to be limited and excluding. People living in the home were, at some times of the day, ignored and their needs were not addressed in a consistent manner. The deployment of staff at the home needs to be reviewed so as to make sure that all residents needs are met at all times. Routines within the home need to be improved so that these are resident led rather than staff orientated. Some elements relating to medication practices and procedures need to be reviewed so as to ensure residents safety and wellbeing. Further training and personal development is required for some staff so as to ensure they have the skills and competence to meet residents’ needs and to deliver good care. People must be provided with meaningful activities so as to ensure that their social care needs are met both at the home and within the local community. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 8 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.V367616.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.V367616.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect that they will be properly assessed prior to admission and assured that their care needs can be met. EVIDENCE: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective resident’s needs. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital. On inspection of six care files for those people newly admitted to the care home (Benbow, Jellicoe, Mountbatten and Nelson), evidence showed that pre admission assessments were completed by the management team of the home prior to the person’s admission. Records showed that only one assessment was Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 11 completed on the day of the person’s admission, however no rationale as to the reason for the emergency admission was recorded. Information recorded within the pre admission assessment format was seen, to be detailed and informative and included a `Map of Life` and Lifestyle Profile (detailing individual’s past life, routines and rituals), however care must be taken to ensure that information from the pre admission assessment document is transferred to the individual person’s care file. This will ensure that important information about the individual person is highlighted/recorded and not lost and staff have all the necessary information they require to meet individual’s care needs. The Annual Quality Assurance Assessment (AQAA) details under the heading of `what we do well`, “All prospective residents undergo a pre admission assessment to ensure the home can meet any identified need and the placement will be appropriate”. It was positive to note that there was evidence to show that the pre admission assessment had been undertaken in most cases with the resident and/or their representative and people had been offered the opportunity to visit the care home prior to admission. The AQAA details, “We also encourage families to come and look round first before they make their mind up about our facility”. Relatives spoken with during the inspection and from inspection of completed surveys showed that they received sufficient information about the home so that they could make an informed decision as to whether or not Admirals Reach is the home for them. The home does not provide intermediate care. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents are generally happy with the care provided, shortfalls in care planning and risk assessing were highlighted, which could potentially have an adverse affect on outcomes for residents and their wellbeing. EVIDENCE: At this inspection a random sample of 8 care files were examined in total, from within the four houses (Benbow, Jellicoe, Mountbatten and Nelson). There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by care staff, however not all areas of identified need were recorded within each person’s care plan and in some cases there was limited information recorded as to how staff were to proactively manage the person’s care needs. Care records within the four houses were inconsistently recorded and showed care records on both Benbow and Jellicoe requiring further development. The care planning and risk assessment processes within both houses identified shortfalls Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 13 which, potentially place residents at risk of not having all of their care needs met and provides staff with inaccurate and not up to date information about individual residents. The daily care records for one person recorded them as regularly refusing food and drinks and having a small dietary intake. Additionally the nutritional assessment showed that over a seven month period the resident had lost over 5KG in weight, however there was no care plan and/or risk assessment in place as to how the above was being monitored or proactively managed. There was no evidence to suggest that the management team of the home had sought advice from a healthcare professional and/or the resident’s GP. Additionally records also detailed that the resident had developed a pressure sore, however from inspection of their care file, there was no care plan or risk assessment detailing treatment and/or action to be taken. It was of concern that the senior person in charge of the house, informed the inspector that the person’s pressure area care “had only just been noticed”, however daily care records showed that the pressure sore had been prevalent for several days and treatment provided by staff. The AQAA details under the heading of `what we do well`, “All residents have comprehensive personal care plans individual to their identified needs” and “Any pressure ulcers are recorded”. It also states under the heading of `what we could do better`, “Improve care documentation”. The above does not concur with the inspector’s findings and potentially places people at risk of not having all their care needs met. Care records showed that all people who reside in the care home have access to a range of healthcare provision and services as and when required. The home’s nursing staff provide assistance and care to those people admitted for nursing care, whilst arrangements are in place for the community nurse/district nurse services to provide care and support to those people accommodated for residential care. Nursing staff spoken with at the time of the site visit, confirmed that there is a good relationship with the visiting doctors surgery and other healthcare professionals. Rapport between staff and residents was inconsistent within the four houses, with some staff interacting well with residents, whilst other staff were observed to be very distant, to not talk with residents and to only verbalise with residents when conducting a task e.g. carrying out personal care and/or when relocating a resident from one area of the home to another. The majority of medication is managed through a monitored dosage system (blister pack). Medication practices, procedures and records were examined within each of the four houses over the two days of inspection. Storage systems within each of the houses for medication were seen to be appropriate and secure. Temperatures for the storage room and the dedicated fridge used to store medicines in each of the houses were regularly recorded, however the records of fridge temperatures within one house (Jellicoe), Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 14 showed these were regularly above the recommended levels of between 2-8° centigrade. This is unacceptable as the failure to store medicines under suitable temperatures may result in residents receiving medication, which is ineffective. Medication Administration Records (MAR) were examined and these showed that records were completed and up to date within Benbow and Nelson, however on the remaining two houses there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR (Medication Administration Record) record had been left blank and not signed/initialled by staff. Other discrepancies were noted in relation to some medications being stored, which had passed its expiry date, not all packets/bottles of medication were signed and dated when opened as part of good practice procedures, where `O` other was recorded, the rationale was not always recorded on the reverse of the MAR record, handwritten MAR records were not always double signed as part of good practice procedures and some MAR records did not always include the date medication was received. The house manager on Nelson was advised to ensure that prescribed medication for individual residents is administered in line with the prescriber’s instructions. Actual administration of medication to residents was seen to be appropriate on both days of the inspection within three houses, however on Benbow one member of staff was observed to handle medication whilst dispensing the medication into individual pots. This is seen as poor practice as this could change the properties of some medications. An audit of controlled drug medications was checked against records and these were seen to be in good order and reconciled. The staff, training plan evidenced that staff who administer medication last received training in 2004. Of those staff files randomly inspected there was no evidence to show that staff who administer medication are assessed as to their continued competency. As part of good practice procedures this should be reviewed. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 15 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. The activities programme at the home does not meet the social care needs of all people living at the care home. Not all residents have their nutritional needs met and this means that some residents do not receive a varied and balanced diet, which could affect their health and wellbeing. EVIDENCE: Over the period of two days a significant amount of time was spent observing residents and staff interaction. There are four separate houses within Admirals Reach, which provide care and support to a range of people with varying different needs. From observation on the different houses, the current activities programme does not meet the needs of the people who have high complex needs/diagnosis of dementia. From observations and discussions with people living in Nelson and Mountbatten, it was evident that the option of being involved in a range of activities was available. One person spoken with said how much they had enjoyed the week of different activities relating to being on a cruise ship. The resident said “I went to Spain once on holiday, it took me back”. Another Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 16 resident said, “ I really like the entertainment that they organise, it’s something different”. This is in contrast to the residents who live in the houses of Benbow and Jellico who suffer from dementia. As part of the inspection the registered manager was consulted about the development of the activities provided for people with more complex needs. The response received was that “Activity hours have been increased to 100 hours, and activity staff has been provided with training to enhance their skills to work with people with dementia.” Whilst this is acknowledged, observations showed very limited evidence of any specific activities tailored to meet the needs of those people with dementia. The first day of the inspection was on a Wednesday, and the activity coordinator based in Jellicoe was off sick. The activity co-ordinator working in Benbow advised that in this situation the co-ordinator would share her time between the two houses. This meant that very little time was allocated to the residents in each house. Between 8.15 and 11.10, no activities were observed being undertaken with residents in Benbow. There were six members of staff on duty throughout this period, all of whom seemed very busy. Six residents spent at least an hour sitting in armchairs with limited or no communication from a carer. The T.V was on, but the residents did not appear to be watching it, and were disengaged. At 11.20 activities were observed in Jellicoe. The co-ordinator was massaging residents’ hands. This was offered individually, and therefore not everyone was able to join in. The coordinator was spoken to, and advised that they had not received any training related to massage, but it was observed that residents really enjoyed the physical contact. The Bingo game that was usually played with residents from both Jellicoe and Benbow in the afternoon had been cancelled, due to the activity requiring two members of staff. No further activities were observed being offered to residents in either of the houses on that day. The second day of the inspection was on a Friday. Activities were observed in Nelson house. The co-ordinator was seen to engage residents in an activity that was both physically and mentally stimulating. Two residents were sat in chairs whilst the co-ordinator facilitated a balloon game. The balloon was knocked backwards and forwards and residents were being helped to try to count. The co-ordinator used a white board which residents wrote on whilst completing an easy quiz. The activity programmes were written in the same format for all four houses, but do little to inform people as to the specific choices/activities available. Consideration should be given to devising the activity programme in larger print/simple language and/or pictorial format, so as to enable people living within each house to make an informed decision. Although a menu was displayed within each of the houses, the menu’s within 3 of the houses was not reflective of what was actually available to residents. Residents spoken with within 3 houses, were unable to advise inspectors as to Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 17 what was available for lunch/tea. The manager of the service was advised to consider the devising of a larger print/pictorial menu so as to enable residents to make an informed choice. During the two-day inspection, meal times were observed at different times of the day and within different houses. The dining experience for people across the service varied from house to house e.g. some staff within two houses (Benbow and Jellicoe) were observed to outpace residents, by hurrying people to eat their meal and not giving them sufficient time to swallow their food before the next spoonful was given, resident’s provided with a plated meal/pureed meal not advised as to the items presented, some staff whilst assisting individual resident’s provided very little verbal interaction and residents were not always asked if they had finished their meal before plates were taken away. One resident who was provided with a pureed meal, confirmed to the inspector that they would have liked to know what was available. It was also disappointing to note that some pureed meals were mixed together and not portioned separately. We recognise that both houses provide support to people who have a diagnosis of dementia and that their needs, are more complex than those people living on Mountbatten and Nelson, however irrespective of residents care needs, all people within the service should be shown respect, dignity and where people require assistance and help with eating, staff are sensitive in their approach. In contrast on Mountbatten and Nelson, the dining experience for people was observed to be unrushed, staff asked residents if they had finished their meal before plates were taken away and residents were offered second helpings of both food and drinks. Additionally, staff interaction with residents was observed to be positive and there was a lot of banter between staff and residents and included those people who have limited communication skills. Residents within both houses were noted to make positive comments, “oh, I have no complaints the food is lovely”, “it always looks so nice and tastes good” and “the food is very good, very enjoyable”. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their concerns will be listened to and acted upon, however they cannot assume that staff working within the care home will manage and/or deal effectively with issues relating to dealing with challenging behaviour as there are shortfalls in staff’s training. EVIDENCE: Staff spoken with, were aware of the complaints policy, and able to advise where a copy was on display. Staff, generally were very proactive about ensuring residents concerns were reported and one person said “wherever possible we try to resolve any concerns, but we are also happy to help residents make a complaint when necessary.” The home has received four complaints since the last inspection and all were dealt with, in the set timescales stated in the homes procedure. Safeguard training has always been part of the homes mandatory training programme, but due to concerns raised at the last inspection, this has been given a higher priority in the home. All staff spoken with had attended training since the last inspection, and had sufficient knowledge to respond to any possible concerns. The manger stated in the AQAA that “ We deal with abuse /pova in the most robust manner.” Evidence suggests that this is the case and that any concerns will be dealt with promptly. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 19 As detailed above, the training matrix records most staff as having up to date safeguarding training, however there was little evidence to show that staff have received training relating to challenging behaviour/dealing with aggression. From inspection of care files and from observations, there are people living within the service at Admirals Reach who display inappropriate behaviours, both verbally and physically and who are resistant to care. During the inspection it was concerning to observe staff adopting poor care practices in relation to one resident on Jellicoe House. Both inspectors observed chairs being placed in front of a doorway from a smaller lounge area to stop a resident entering a larger lounge where people were being assisted to eat their meals. When questioned, staff stated this was to stop the resident from taking other people’s food/drinks, however this conflicted with the manager’s explanation. Inspectors were advised that the resident continually paces up and down and concerns had been expressed that they were losing a lot of weight as a result of their physical activity. Both staff and the manager were advised that the above is deemed as restraint and alternative ways of managing the person’s behaviours must be explored. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The four separate houses provide a safe, well-maintained environment, which meets the needs of the residents who live there. Attention should be given to eliminating the odour in Benbow. EVIDENCE: The home employs a full time maintenance officer who manages the day-today maintenance in all four houses. Part of this role is to ensure regular checks re fire, servicing of hoists, gas and electricity appliances etc are completed. Documentation looked at confirmed that a range of outside contractors completes this regularly. A maintenance programme is in place, and refurbishment was due in January of this year, I was advised that there had been some delay, but this was now imminent. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 21 Staff advised that any maintenance issues are recorded in a book, and are dealt with promptly. The maintenance officer is a valued part of the team, and attends staff meetings, and is offered all related training, which applies to their work/role. Each house has been decorated with domestic style fixtures and fittings. This is a difficult task has at times residents require a high level of nursing care, and associated equipment is located in their own personal space i.e. bedroom. Bedrooms were individualised, reflecting personal taste, and where residents were not able to choose what they would prefer in their rooms, relatives and staff had made an effort to assist. No health and safety issues were highlighted during either day of the inspection. On the first day of the inspection, two hours were spent in Benbow house. The smell of urine remained, and despite staff stating that every effort was made to eliminate the smell, this was not the case on both days of the inspection. There was no evidence of any odours detected in the other three houses. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. The level of staffing and staff deployment within some houses, restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Whilst outcomes for residents are generally sound, some shortfalls in staff training pertaining to those conditions associated with the needs of older people mean that some staff may not be able to meet the needs of the residents living at the home. EVIDENCE: Each house is staffed independently according to the numbers and needs of residents. Staffing levels across the site are 6x staff 08.00-20.00 and 3 waking night staff 20.00-08.00 (Benbow), 7x staff 08.00 14.00, 5x staff 14.00-20.00 and 3x waking night staff 20.00-08.00 (Jellicoe), 5x staff 07.30-14.30, 3x staff 13.00-20.00, 1x staff 14.30-21.30 and 3x waking night staff 20.00-08.00 (Mountbatten) and 6x staff 08.00-14.00, 5x staff 14.00-20.00 and 3x waking night staff 20.00-08.00 (Nelson). Additionally inspectors were advised that on 2 days a week during the morning, there are 7 members of staff on Nelson, for when the GP visits. From talking to staff throughout both days of the inspection, inspectors were advised that on some occasions, staffing levels as detailed above are not always maintained. From evidence of 4 weeks staff rosters for each of the Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 23 houses, this was confirmed. Staff spoken with stated that depending on the numbers of residents and their needs at any given time, care delivery to people residing in the houses can be difficult and challenging if there are staff shortages as a result of sickness/annual leave. Wherever possible every effort is made to staff the houses as detailed above from within the organisations existing staff team/bank staff or from an external employment agency, however this is not always possible. We have not received any Regulation 37 notifications advising us of the staffing shortfall and measures undertaken to deploy staff to the home. The manager of the service advised that the high usage of agency staff within the home has greatly improved over the past 3 months as a result of a successful` recruitment drive`. It is positive from discussions with both the manager and house manager’s, that they have full autonomy to book agency cover as and when required. The deployment of staff to ensure that residents care needs are met and people are supported throughout the day varied from house to house. There were occasions whereby residents were left without support in lounge areas for timed periods e.g. on the second day of inspection 8 residents were left within one lounge for 10 minutes without any staff support. A copy of the staff, training matrix for each house was provided to inspectors at the time of the inspection. This showed that since the last inspection some staff across the service had received training relating to fire awareness, moving and handling, health and safety and safeguarding, however there was evidence to suggest that several staff members require updated training in core areas such as food hygiene, COSHH (Control of Substances Hazardous to Health), infection control and dementia awareness. The manager must also consider training for staff, in relation to those conditions associated with the needs of older people e.g. parkinsons disease, sensory impairment, diabetes, nutrition, falls management etc. It is of concern that within the two houses, which provide care for those people with a diagnosis of dementia, the records show that few staff had received training relating to challenging behaviour/dealing with aggression, yet from discussions with staff, there are people living within both houses who display inappropriate behaviours or who are resistant to care on occasions. The manager advised inspectors that at the time of the site visit, 10x staff had attained NVQ Level 2, 1 member of staff had achieved NVQ Level 3 and 15x members of staff were working towards a NVQ qualification. A random sample of 6 staff files, were examined for those staff newly employed at Admirals Reach. Recruitment procedures at the home were observed to be robust and in line with regulatory requirements. The manager advised that at the time of the site visit, there were 300 vacant care hours across the service for both full/part time staff. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 24 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements do not effectively support consistency of care in all units, and therefore the quality of service offered to residents is variable. EVIDENCE: The manager is registered with the Commission; she is experienced in the care of elderly people. As part of her commitment to on going training she has completed the higher national diploma in health services management (specialising in the care of the elderly). At the current time the manager is undertaking further training (Masters in public health) that means she is absent from the home for a period of two days per Week. In her absence her role is covered by one of the four house managers. The management structure within in the home has only two tiers the manager, and the four unit Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 25 managers. From observation the unit manager has a key role in the way care is delivered to residents in each unit. The current acting up process by the heads of unit to cover the manager in her absence takes them away from managing the individual units, and impacts on service delivery, by staff feeling insufficiently supported. It is therefore recommended that a deputy manager be appointed to act up in the managers absence, and also have a more hands on role in supporting and motivating staff in Jellicoe and Benbow where morale appeared lower then in the other two units. On the first day of the inspection there were 6 staff, and one person on induction in Jellicoe to care for 28 residents. This is a ratio of one to four/five staff to residents. This ratio is similar in Benbow, the other unit that also provides long term care for people who suffer from dementia. The manager stated in the annual quality assurance assessment that 76 residents require two or more people to help with their care. When interviewed she acknowledged that the bulk of these residents are based in either Benbow or Jellicoe which again means that often two staff members maybe supporting one resident at any set time. Staff reported that agency staff was often employed, to cover staff vacancies and sickness. This often reduces the number of staff who knows residents, and impacts on the skill mix of staff providing care. One staff member interviewed said “many staff were stressed, and had been off sick putting further pressure on the remaining staff”. Another person said the work was “rewarding, but demanding and challenging”. Staff generally felt that the morning shift, and between 5pm and 7pm was when residents required a high level of support with feeding and personal care. The Manager advised that the staffing levels had been reviewed since the last inspection and were sufficient to meet the needs of residents; as both Benbow and Jellicoe currently had vacant beds, and staff, were not working with a full occupancy. This would further be reviewed as further admissions of residents were agreed. Supervision of staff is taking place, and evidence was looked at i.e. notes to suggest these have happened. Team meetings are regular, and the Manager stated that most staff is able to attend. The morale of staff did appear low at times within the two houses where people who have a diagnosis of dementia live. It is essential that the manager considers how staff, can be supported to improve this. Bupa is a large organisation with set policies and procedures to be followed within all services, and accordingly annual audits are carried out for the purpose of it’s own quality assurance system, and compiles a report of the findings. All of the records required by regulation are kept correctly. The home had a clear health and safety policy statement, and additional information and guidance on various aspects of health and safety. Staff interviewed was aware Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 26 of policies and procedures and stated that as part of supervision, and team meetings they would be updated when necessary. Records looked at showed that appropriate servicing and checks were carried out on facilities and equipment. This is undertaken by the maintenance officer employed in the home that was spoken to as part of the inspection. The fire logbook provided evidence that regular fire alarm checks, extinguisher checks and emergency lighting checks took place. The maintenance officer reported that fire drills were under taken on a 3 monthly basis, and evidence was available to confirm this. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 3 Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 28 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 Requirement Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information, so as to ensure people’s safety and wellbeing. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Ensure that records relating to the incidence of pressure sores, treatment and equipment required for an individual person is clearly recorded within their care file. This will ensure that staff working at the care home know the person’s care needs and residents will be assured that their care needs will be met. Residents must be protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions so as to ensure their health and wellbeing. DS0000015345.V367616.R01.S.doc Timescale for action 01/11/08 2. OP7 13(4) 01/11/08 3. OP8 17(1)(a) Schedule 3 (3)(n) 01/11/08 4. OP9 12(1)(a) 13(2) 18/07/08 Admirals Reach Residential & Nursing Home Version 5.2 Page 29 5. OP9 12(1)(a) 13(2) 6. OP9 13(6) 18(1) 7. OP9 13(2) 8. OP12 16(2)(m) and (n) 9. OP15 12(1)(a) 12(4)(a) 10. OP18 13(6) Ensure that medication utilised at the home is not stored beyond its expiry date as it could lose its effectiveness and pose a potential risk to residents. Ensure that all staff authorised to administer medicines have been trained and assessed as competent to do so. This will ensure that unnecessary risks to the health and wellbeing of residents are avoided. Ensure medication is stored under suitable environmental conditions to prevent residents being put at risk of harm by receiving unsuitable medication. This refers specifically to medication stored within the dedicated fridge. Ensure that all residents receive a varied programme of stimulating and interesting activities both `in house` and within the local community so as to ensure people have their social care needs met and do not become bored. Ensure that the dining experience for residents is positive and that people who require assistance to eat their meal, are assisted by staff in a sensitive and dignified manner. Ensure that all staff within Benbow and Jellicoe, receive training relating to dealing with challenging behaviour. This will ensure that staff have the skill, competency and confidence to deal with situations as they arise and residents living within the home will be assured that they will be kept safe and that their needs will be met. 18/07/08 18/07/08 18/07/08 01/11/08 18/07/08 01/01/09 Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 30 11. OP26 16(2)k Action must be taken to deal with odours where they persist so as to provide a pleasant environment for residents and their visitors. This requirement was not fully met from the previous 2 inspections. Previous timescale 1/4/08. Staffing levels must be reviewed and maintained so as to ensure that resident’s needs are met. This requirement is outstanding from previous inspections. The previous timescale of 30/3/08 not met. Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. 01/10/08 12. OP27 18(1)(a) 01/10/08 13. OP30 18(1)(c)& (i) 01/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP12 Good Practice Recommendations Handwritten MAR records should be double signed/witnessed by staff so as to ensure that the information transferred is correct and accurate. Consider devising the activity programme in a larger print/simple language and/or pictorial format so as to ensure that people within the care home are able to make an informed choice. Ensure that menu’s displayed for residents are reflective of meals being provided on the actual day. DS0000015345.V367616.R01.S.doc Version 5.2 Page 31 3. OP15 Admirals Reach Residential & Nursing Home 4. OP15 Consider devising the menu’s in larger print/simple language and/or pictorial format so as to ensure that people within the care home are able to make an informed choice. Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Admirals Reach Residential & Nursing Home DS0000015345.V367616.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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