Inspection on 06/09/06 for Allenbrook Nursing Home

This inspection was carried out on 6th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Allenbrook Nursing Home 17/07/08

Allenbrook Nursing Home 26/10/05

Allenbrook Nursing Home 01/06/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Allenbrook Nursing Home 34 Station Road Fordingbridge Hampshire SP6 1JW Lead Inspector Tim Inkson Unannounced Inspection 6th September 2006 09:30 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 Allenbrook Nursing Home DS0000064164.V307295.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. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Allenbrook Nursing Home Address 34 Station Road Fordingbridge Hampshire SP6 1JW 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) 01425 656589 01425 655410 Allenbrook Care Ltd Mr John Walker Care Home 43 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (43), of places Physical disability (8), Physical disability over 65 years of age (43), Sensory Impairment over 65 years of age (43), Terminally ill (8), Terminally ill over 65 years of age (43) Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Individuals in the categories of PD and TI must be aged between 50 to 64 years of age. 26th October 2005 Date of last inspection Brief Description of the Service: Allenbrook is a large Georgian period country house situated in extensive grounds and it was converted for use as a nursing home. It is owned by Allenbrook Care Ltd, a company formed with the specific purpose of purchasing and owning the care home and the day-to-day operation is the responsibility of managing agents, BML Healthcare Ltd. The home is located within a quarter of a mile of the small country town of Fordingbridge, with all its amenities. There is limited bus service from Fordingbridge to the centres of Ringwood and Salisbury the nearest large centres of population. The nursing home has three floors on which service users are accommodated. A passenger lift provides access to all floors. The home’s communal rooms comprising a lounge dining room and a separate lounge and a large sun lounge/conservatory are all located on the ground floor. Communal WCs and baths are located on all floors. Other facilities provided include a laundry service and full board. The home provides a limited meals on wheels service to people living in the local community. Potential residents are sent a brochure and given verbal information about the services the home provides they are also invited to visit the home. When an individual moves into the home they receive a “welcome pack” that includes the home’s “Service Users Guide” and a copy of a report of the last inspection made of the home by the Commission for Social Care inspection. At the time of the fieldwork visit to the home on 6th September 2006, the home’s fees ranged from £500 to £690 per week. The fees did not include the cost of hairdressing; chiropody; the installation and running costs of private telephones and dry cleaning. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 6th September 2006, starting at 09:15 and finishing at 16:35 hours. The process included viewing the accommodation including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practices was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 43 residents and of these 11 were male and 32 were female and their ages ranged from 65 to 98 years. There was no resident from a minority ethnic group. The home’s registered manager was on holiday but the deputy manager was present throughout most of the visit and she, the home’s administrator and registered nurses on duty were available to provide assistance and information when required. Other matters that influenced this report included a pre-inspection questionnaire with documentation completed and provided by the home’s registered manager. There were also 9 comment cards received from residents of the home and 5 received from relatives/friends of residents. Information that the Commission for Social Care inspection had received since the last fieldwork visit, such as copies of reports of monthly visits made to the home on behalf of the owner and statutory notices received about incidents/accidents that had occurred were also taken into account. What the service does well: Detailed information was obtained and recorded by the home about the help that residents required both before and after they moved into the home. This helped to ensure that the care and support they received was planned properly and their needs were met. Potential risks to residents’ welfare were identified and documented and plans put into place to eliminate as far as possible any harm that individuals could suffer. The home liaised with specialist healthcare professionals to that ensure that residents’ healthcare needs were managed appropriately. Residents felt safe and secure and happy that staff could look after them properly and treated them with respect and relatives valued the relative stability of the staff team that had changed little over a number of years. Residents were able to participate in a range of social and other activities that were organised by the home. Individuals that were bedfast were given one to one attention. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 6 The home promoted the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. The food that the home provided was enjoyed by residents and visitors. There was a strong commitment to staff training and development to ensure that they were able to fulfil their roles and responsibilities and meet residents’ needs. Staff members and visitors had confidence in the abilities and admired the personal qualities of the home’s registered manager. Management systems and procedures in the home worked well including, dealing with complaints, quality monitoring, and health and safety. What has improved since the last inspection? 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. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a system in place for identifying the needs of potential residents before they moved into the home to ensure that they could be met. EVIDENCE: The home had written policies and procedures concerned with the admission of new residents to the home and these referred to the importance of ascertaining the help required by potential residents before they moved into the home. The home’s statement of purpose included the following paragraph: “The decision to admit a new resident is taken by the home manager after a full pre-admission assessment that demonstrates that we are able to meet the totality of their care needs”. A sample of the records of 4 residents was examined including those concerned with identifying the help and care that people needed. There was evidence from these documents and discussions with the residents including Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 9 those whose records were examined. That the admissions to the home of the individuals concerned had all been planned with staff with the appropriate knowledge and skills who had visited the potential residents and identified the help and support that they needed before they moved into the home. Some comments from individuals spoken to about this process included: • “Mr Walker (the registered manager) came to see me when I was at home to see what help I needed”. • “Someone from here came to see me at home before I moved here and asked me what I could and couldn’t do”. It was not evident from the records examined that potential residents were written to before they moved into the home informing them that the home could meet their assessed needs, as is required in accordance with Regulation 14(1)(d) of the Care Home Regulations 2001. The home’s pre-admission assessments and were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure; the personal and healthcare needs of residents were met and medication was managed safely and effectively. Among other things staff working practice ensured that residents’ privacy and dignity was promoted. EVIDENCE: On this occasion as on previous inspections of the home on 1st June and 26th October 2005, a sample of the care plans of residents was examined (4). The documents were detailed and the plans were based on assessments the home carried out in order to identify what help individuals needed (see also page 10). The plans set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. The documents examined included assessments of a range of potential risks to residents e.g. pressure sores; falls; nutrition; moving and handling; malnutrition; etc. Where assessments identified a risk there was a corresponding plan in place to reduce or eliminate the potential harm to the individual e.g. a high risk of developing a pressure sore resulted in the provision of appropriate equipment such as “egg box” cushions on chairs and alternating air mattresses on beds. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 11 As on previous inspections observation and discussion with residents confirmed that individuals received the help they required and that the equipment was in place as set out in their plans of care. Records indicated that assessments were reviewed at least monthly and care plans were reviewed at least every 3 months. There were also daily notes/records that referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from residents and relatives about the abilities of staff the care and support that the home provided included: • “The girls are quite helpful if I ask them – they are very good they know what they are doing” • “The only help that I need is with bathing and they are very good. They do preserve my modesty. They always knock on my door before they come in and they come in at night to see if I am alright. If I go off in a coma they bring me around, they certainly know what they are doing. They test my blood twice a day, and if it is low they give me something to eat and make sure that I am alright before I go to bed. They take me to the diabetic clinic and I also go there for chiropody” • “The staff are fine, they help me with washing and dressing and bathing”. • “The girls are very nice, they give me quite a bit of help one way or another”. • “If I have to go anywhere I am moved in a wheelchair. If I need help and ring then somebody comes. They help me with a bath and help me dress. It is a lady that does it, they did have an agency male nurse one night but he was alright”. • “They are looking after me well and truly. I had a stroke and it damaged my left side – they give me a lot of help. I had a bath yesterday and they know what they are doing when they help me. I have to wear a pad and they change it regularly when they do that they make sure that the door is closed and they use a screen if they need to”. Comment cards were received from 9 residents and all indicated that they felt well cared for and that their privacy was respected. Comment cards were also received from 5 relatives and all indicated that they were satisfied with the overall care that the home provided. There was no evidence from the care plans that were sampled or discussion where that was possible with the individuals concerned that either they or their representatives signed the plans to indicate that they had been involved in developing the plans and agreed with the contents. Records examined also indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for residents when it was necessary. Residents spoken to said that they saw and received Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 12 treatment from among others, doctors, podiatrists and dentists and when required arrangements to attend outpatient clinics were made by the home. During this fieldwork visit it was noted that a resident was being taken out by a member of staff to visit a local dental practice. There was also evidence that the home made referrals for and arranged specialist support when required e.g. palliative care team. Individuals’ health was monitored routinely and regularly e.g. blood pressure and weight. Comments from residents about the healthcare arrangements that the home made included the following (see also some comments made above): • “A chiropodist comes and does my feet”. • “I went to the dentist this morning. A man comes to see me about my feet”. • “I saw a doctor when I first came. They weigh me and take my blood pressure. I see a chiropodist and have my nails done”. There were comprehensive written policies and procedures available concerned with the management and administration of medication. (See below reference to requirement at last inspection). Medication was dispensed from original containers. Medicines were stored safely and appropriately in; two locked and secure medicine metal trolleys; a locked metal cabinet in a locked secure room; and in a medical refrigerator. The temperature of the latter was regularly checked to ensure that it was working effectively and medical equipment was regularly serviced. The administration of medication in the home was the responsibility of registered nurses. There were copies of the signatures of those nurses who dispensed medication. The records concerned with this process were examined and they were complete and up to date on this occasion. (See below reference to requirement at last inspection). Other records concerned with the management of medication included those concerned with the ordering, receipt and disposal of medicines. A check of records of some controlled drugs indicated that stocks being held were correct. General practitioners had given written permission for the use of certain unprescribed or “homely” medications if their use was considered necessary e.g. cough linctus. Residents were able to self medicate subject to a risk assessment, but none were doing so at the time of this fieldwork visit. There was reference material available in the home to look up information about medicines but a copy of the British National Formulary (BNF) that the home used was 3 years out of date. It is recommended that a more up to date copy be obtained. The home’s deputy manager said that the home had Internet access to a site where information and advice about medication could be obtained. A requirement was made at the last inspection on 26th October 2005 to address the following issues: Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 13 Production of updated the written policies and procedures to reflect accurately the practice in the home, • Keeping of accurate and complete medication administration records. There was evidence that these requirements had been actioned. The home’s statement of purpose included information about its philosophy of care including among other things the promotion of residents’ privacy and dignity. It stated: “All members of staff are trained to strive to preserve and maintain the dignity, individuality and privacy of all residents within a warm and caring atmosphere, and in so doing will be sensitive to the residents ever changing needs”. Most residents were accommodated in singe rooms and they said they appreciated the privacy that these afforded, and particularly those that had the benefit of en-suite WCs. In rooms that were shared screens were available to provide privacy. Residents spoken to also said staff usually knocked before entering their rooms and this practice was observed during the inspection visit. Residents and relatives spoken to described the staff as respectful and polite and of the 9 comments card received from residents all indicated that their privacy was respected and all 5 returned from relatives and friends stated that they could meet with the person they were visiting in private. Comments about these matters included the following (see also comments above): • “The staff are nice and polite” (resident). • “The staff are very polite – they always knock on my door. I think it is very homely – I don’t think that you could have kinder staff –they are always helpful and you never get the impression that they are fed up with people and they must do – everything is taken slowly and nicely (resident). • “They put a screen there for my privacy, and they are very polite”. • “It is quite good and the people here get treated with respect” (relative). Care plans examined included aims that among other things included maintaining the person’s dignity. • Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home organised a range of social activities that provided stimulation and it also promoted residents self-determination, enabling residents to exercise choice about all aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were well catered for with a balanced and varied selection of food available that met their tastes and choices. EVIDENCE: The home’s statement of purpose included the following information: “The home offers a wide range of activities designed to encourage the client to keep mobile and most importantly take an interest in life. Staff encourage and in certain instances help residents to pursue their hobbies and interests”. The plans of care examined (see at pages 11 and 12) included details about individuals’ leisure interests and preferred lifestyles. The home employed 2 staff with some of their time specifically dedicated to organising activities in which residents could participate. Information about planned events was made available to residents and copies of the programme of activities organised for September 2006 were noted in a number of bedrooms seen during a tour of the premises. These included; a bus trip; cream tea; bingo x 2; 2 separate singers; foot therapy; visiting shop; games; and manicures. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 15 Some residents spoken to said that they were able to enjoy the activities that were arranged, and others indicated that they preferred their own company. Out of the 9 comment cards received from residents, 7 indicated that the home provided suitable activities and the other 2 indicated that sometimes the home arranged activities that they thought were suitable. A member of staff spoken said that residents who were unable to get out of bed because of their condition or level of frailty received individual attention from the activities organisers and other staff. Comments made by residents and relatives spoken to during this fieldwork visit about activities included: • “I come 2 to 3 times a week and there is singing there are bonfire parties, garden parties, cream teas and outings for those able to go (relative). • “We have bingo and I join that because I like bingo. We can go out in the bus, I did but I forget when that was” (resident). • “We usually go out on the bus a couple of times a month. We have bingo and things like that and we have singers a couple of times a month (resident). • I have been to the bingo and various people singing but I am inclined to stay here in my room (resident). • “G comes and gives me a foot massage” (resident). • “I sit and read and I like the television…” (resident). • “There are activities if I want to join in but I am happy to sit and watch TV” (resident). Residents spoken to confirmed that they could exercise choice in all aspects of life in the home and comments from them about life in the home included: • “You don’t have to get up if you don’t want to”. • “I could see clergy if I wanted to but I am not a churchgoer. I prefer to have my meals in my room”. • “I can do what I please, I don’t have to be up by a certain time which is nice”. • “There are not really any routines, I could stay in my room all day if I wanted to”. One relative who visited the home frequently said, “I have never seen anyone forced to do anything”. The home’s statement of purpose stated the following about “Contact with family and friends”: “Residents family, relatives and friends are encouraged to visit the residents, regularly and maintain contact by letter or telephone when visiting is not possible…. Visitors will be welcome at all reasonable times …..The resident has the right to refuse to see any visitors, and this right will be respected and upheld by the manager who will, if necessary, inform visitors of the resident’s wishes”. During this fieldwork visit a number of visiting relatives were seen and some were spoken to about their ability to make visits to the home. Comments from Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 16 residents and visitors about visiting arrangements were all positive and included the following: • “I have been coming here for 2 to 3 years now and there have never been any problems. It is very relaxed” (visitor). • “I have been coming for nearly 5 years. I have seen a few changes but staff have stayed which has been the main thing. Visiting is very open I can come at any time. I am made very welcome and I am always offered a cup of tea” (visitor). • “I can come here at anytime. I have a meal when I come and it is very good”. • “You can have visitors when you like. My daughter visits at weekends and my friend comes most weeks”(resident). Although most residents handed over the responsibility of the management of their finances to relatives or representatives, some individuals continued to control their own financial affairs. Residents were able to bring personal items into the home including furniture and it was noted during a tour of the premises that several individuals had taken trouble to personalise their bedrooms. It was noted that care plans were kept in an area of the home that functioned as a nurses’ station the security of confidential information was discussed as there was not always a member of staff present in that area. Other sensitive information about residents was kept securely in locked filing cabinets in the home’s office. The home had written policies and procedures about the control of records and access to personal files. There was information in the entrance hall of the home about an organisation that could provide independent advice, information or advocacy services for residents and/or their relatives. The provision of meals was referred to in the home’s statement of purpose and it stated the following: “Menus will be varied and favourite dishes and special diets can be catered for. Residents are encouraged to eat in the dining room but may eat in their own room or the conservatory if they choose. Tea, coffee and other hot drinks are served and available 24 hours a day, visitors are also catered for”. All residents spoken to were complimentary about the food provided but of the 9 comment cards received from residents 7 indicated that they liked the food and 2 indicated they only liked it sometimes. All residents spoken to confirmed that they had 3 meals a day and could have snacks and drinks at other times. The menus and records of food provided indicated that the food was nutritious and there was a range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals and diabetics. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for pureed meals were prepared separately. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 17 Residents could choose where to eat and many preferred to eat in their rooms and they were able to select the meal that they wanted from a menu that was made available to them the day before. Comments about the food provided from residents and relatives included the following: • “The food is very good. You can’t fault the food. There is plenty, well for me there is. I have breakfast, dinner and supper and there is plenty to drink, a boy comes and fills my jug up”. • “I am a bit fussy about food. They come round the day before with the menu and you can have a cooked breakfast if you want. I don’t like fish so I have a salad instead”. • “I have lunch in my room – the food is very good on the whole”. • “The food is very good, there is generally a choice and although they know what they ask me what I would like. I get a cup of tea and biscuit mid morning and they always ask me if I have had enough. I have just had tea and biscuits and I have some mid-afternoon and a drink in the evening”. • “The food looks appetising” (visitor). Allenbrook Nursing Home DS0000064164.V307295.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Robust procedures were in place and they needed to be adhered to in order to properly protect service users from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was displayed in the home’s entrance hall. It was however relatively small and it is suggested that a large print version be displayed to assist individuals with impaired vision. Most residents and relatives that were spoken to and who returned comment cards indicated hat they knew of the procedures and those spoken to said that they were confident about raising any concerns with the home’s manager. • “I would complain to John (the registered manager) if I was unhappy, but everything is lovely”. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and the outcome. There had been no complaints made to the home in the last 12 months and none received by the Commission for Social Care Inspection (CSCI) during the same period. There were written policies and procedures in place concerned with the protection of vulnerable adults from abuse these included the following: • Gifts and gratuities Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 19 • Restraint The home had a copy of the local authority’s adult protection guidelines and this was directly referred to in the home’s procedures about abuse. Staff spoken to were familiar with the home’s policies and procedures and demonstrated an understanding of the different types of abuse that could occur and knew what action to take if they suspected or witnessed any such abuse in the home. This was despite evidence from discussion with staff that that not all of them had attended some type of organised or formal training in the subject of abuse/adult protection. It is recommended that all staff working in the home should receive some relevant training to enable them to recognise and prevent as far as possible abuse of vulnerable residents. The policy about “restraint” referred to above was detailed and unequivocal about what must be recorded in a resident’s case notes when it’s use was considered necessary. It was noted from the sample of care plans examined where bed rails were in use in the case of 2 of the individuals concerned not all the information that the policy required to be recorded was avialble. Particularly details of other interested parties that should be involved in the decision for the use of restraint i.e. relatives; GPs; specialist healthcare professionals; and care managers. The notes for one of the persons concerned stated that, “he declared a reluctance to have the cot “side up””. It is recommended that the recording of the use of restraint should be improved to ensure that residents’ civil liberties are properly upheld. Allenbrook Nursing Home DS0000064164.V307295.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 at least once during a 12 month period. 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 home’s environment was safe and well maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: The exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. Residents and relatives spoken to said that they were generally content with the standard of the home’s décor and furnishings. The home employed 2 maintenance personnel. Large-scale decoration and maintenance was done by external contractors and one of the maintenance personnel said that contractors visited 3 to 4 times a year to decorate parts of the home and had recently been redecorating the exterior of the property he also said: Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 21 • “Among other things I do minor repairs and test the fire alarms – the carpet in the main hallway and corridor is going to be replaced – replacing bedroom carpets is an ongoing thing. I get permission to spend money on repairs and redecoration from BML. They are excellent because if you need it they are prepared to purchase it. You have then got to be prepared to look after it”. As at the last inspection of the home on 26th October 2005 as on this occasion records examined indicated that staff received regular fire safety training and fire drills took place and also that fire safety equipment and systems were checked, tested and serviced at appropriate intervals. A report from a recent inspection by the local fire and rescue service indicated that 7 fire safety items needed attention. At the time of the fieldwork visit all the items had or were in the process of being remedied. The last report (14/10/05) from the local environmental health officer stated among other things: “There are good systems in place with regular documentation and records and good practice to prevent contamination”. The home had written policies and procedures concerned with infection control. The building was clean and odour free at the time of the fieldwork visit and residents and visitors spoken to were all positive about these aspects. • “They keep the place clean- I will say that for them”. • “They are very good, there are 3 or 4 cleaners somebody on each floor”. • “Atmosphere is nice and it does not smell like a lot of places I have been to”. • “The place never smells”. There were sluice disinfectors available on all three floors of the home. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Staff were provided with protective clothing and were observed using it. One of the home’s registered nurses had the delegated responsibility for infection control procedures in the home and some good practice noted during the fieldwork included: • Availability of containers of gel hand cleaner/disinfection. • Liquid soap and paper hand towels in communal WCs. Allenbrook Nursing Home DS0000064164.V307295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents were met. The home had staff recruitment, training and development procedures that ensured that service users were protected and supported. EVIDENCE: The total number of staff employed to work in the home at the time of the fieldwork visit was 57, this included 11 registered nurses and 31 health care assistants and of the latter 17 had a qualification equivalent to at least National Vocational Qualification level 2 in care (i.e. 55 ). Most staff, residents and relatives (including the views expressed in comment cards) indicated that the staffing levels in the home were sufficient and all residents spoken to also expressed confidence in the abilities and competence of the staff to meet their needs. Comments from residents and relatives about the sufficiency and competence of staff included the following: • “There is enough staff, they come when I ring and they are very quick. They help me if I want them to help me”. • “They come on different shifts so it is difficult to tell if there are enough. I need someone around all night and at night there are 3 or 4 of them. They would do anything for you -…” Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 23 • • • “ It is difficult to say if there are enough, but I don’t have to wait long if I need help” “The staff are always helpful and kind. I think that there are enough of them. They say that they work hard but it does not effect me”. “I think that there are enough staff” Comments from staff about the level and numbers of staff on duty at any time included the following: • “Staffing has been good which is unusual for August and the holidays it has been busy but we have covered it. The normal rota is 7 and 2 – it is never enough but in an ideal world it would be 1 to“1”. • “We always want more staff but we do our best and all the staff are genuine”. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 07:00 to 13:30 13:30 to 20:00 20:00 to 07:00 Registered nurses 2 2 1 Health care 7 4/5 3 assistants Total 9 6/7 4 Apart from registered nurses and health care assistants the home employed other staff and these comprised. Administrator Activities organisers Kitchen assistants Housekeeper Cleaners Laundry assistants Chefs Maintenance personnel Records were examined of 3 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 26th October 2005. All statutorily required information and checks had been applied for but the results had not always been obtained before they had started work in the home. Satisfactory protection of vulnerable adult checks (POVAfirst) had been received in all cases for the records examined. However either the standard or enhanced Criminal Records Bureau (CRB) certificate depending on the persons role in the home had not been always received before they started work. The registered persons should know that it is only in “exceptional” circumstances that a person should start work in the home before a Criminal Records Bureau certificate at standard or enhanced level has been received. The level depends on the degree of contact with vulnerable adults the person has. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 24 A new health care assistant was starting work under supervision on the day of the fieldwork visit and although a satisfactory POVAfirst clearance had been obtained an enhanced level CRB certificate had not. There had been no new health care staff employed to work in the home since the last inspection visit apart for the individual referred to above. There was evidence at previous inspection visits and also documentary evidence on this occasion that all new staff received induction training and health care assistants completed a programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). There was evidence from discussion and examination of staff training records that all staff had and continued to attend training in subjects that were essential to ensure that the home was able to promote residents’ welfare e.g. basic food hygiene, moving and handling, and health and safety. Other subjects that staff received training in ensured that staff acquired the necessary skills and knowledge to be able to meet the complex needs of residents e.g. wound management and pressure sore prevention, dementia care, and palliative care. Staff comments about their induction and further training opportunities included: • “I have been here 10 years. We have someone who comes every year and tells us about the chemicals, CoSHH,– we keep them locked away”. • “ I have an NVQ level 3 and I am a moving and handling trainer I just renewed my accreditation last week at a college in Bournemouth. There are 2 of us”. • ““We do lifting and handling, CoSHH, health and safety, fire, so may courses. We do fire about every 3 months. Everyone is doing dementia next week it is someone from outside who is doing the training and some of us have done palliative care”. • “The training I did most recently was health and safety and I am doing dementia next week and I am booked to do first aid”. • “We have done health and safety – we are doing dementia care and wound care and also palliative care”. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s manager provided effective leadership There were systems and procedures in place for; monitoring and maintaining the quality of the service provided; safeguarding residents financial interests and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s registered manager is a registered general nurse with previous experience of managing nursing homes before taking up his current post in which he had been employed for some 11 years. He completed a foundation degree in the management of care homes during the summer of 2006. Staff spoken to indicated that they had confidence in the manager’s abilities and knowledge and that he was supportive. Their comments included: Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 26 • • • • “He is very approachable and is switched on as he is aware of all the issues. He has taught me a lot over the years. You can talk to him about your worries. He finished his foundation degree this summer”. “John is very nice, very supportive, you can go to him with problems and get advice from him”. “John is approachable and he listens. He is knowledgeable and he understands the needs of staff who have a young family” “I don’t think anyone could have a better manager than John”. Comments from residents and visitors spoken to about the home’s registered manager were all positive and included: • “John (the registered manager) is very good, he would do anything for you, he is a friendly, jolly person” (resident). • “Mr Walker seems alright to me” (resident). • “He is excellent and very caring in fact all the senior staff are excellent” (visitor). • “John is very nice” (visitor). There was a section in the home’s statement of purpose that referred to the use of systems to monitor the quality of the service that it provided and that comments were regularly sought about this from residents and relatives. Regular monthly visits to the home had been carried out on behalf of the owners in accordance with Regulation 26 of the Care Homes Regulations 2001. Reports of these visits had been provided to the CSCI and it was apparent from their contents that on these occasions that both residents and staff were interviewed for their views about the way the home was being run. Audits were done of the homes medication systems and also care plans and an analysis was done of accidents that occurred in tee home. There was a written policy available that was concerned with the quality of the service the home provided. It was entitled, “How do we measure the quality of our care and services”. It referred to setting up quality or service circles, a resident and a visitors/families group with the intention that all these groups considered how the service could be improved. None of these groups were operating in the home. There was evidence from discussion with residents and staff that BML Healthcare Ltd (the managing agents) carried out resident satisfaction surveys. The home had a range of policies and procedures that informed care practice in the home. There was evidence with as on previous inspections of the home that these were reviewed and updated or renewed to reflect new legislation and changes in practice. There had been 3 requirements arising from the last inspections of the home and all had been remedied. All residents spoken to were reasonably content and all comment cards received from relatives indicated that they were satisfied with the overall care the home provided and all 9 comment cards received from residents indicated Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 27 that they liked living in the home and felt safe. Views expressed at the time of the fieldwork visit included: • “My friend came to see me and said, I am glad you are here it is very nice”. • “I have been here 2 years in December and it took me a while to settle in. It is very nice”. • “I came last August for respite and then came back again that speaks for itself because there is nowhere like your own home”. • “I don’t suppose there are many places that do as much as this place. I can’t find fault with this place at all”. Staff spoken to expressed enthusiasm for working in the home and comments included: • “I like it- everybody is friendly – you can have a laugh – it is a happy atmosphere – 9 out of 10 staff who leave come back to work here – everybody gets on well”. • “I have been here 11 years - .I enjoy it – the staff do their best for the residents – If I was not happy I would not stay”. The home did not act as agent or appointee for any residents but it looked after some monies on behalf of some residents. The records concerning 2 residents were examined and the balance of money being held for them was correct. Records examined indicated that the home’s equipment, plant and systems were checked and serviced appropriate intervals e.g. passenger lift and hoists; boilers; fire safety equipment alarms, emergency lighting. There were contracts in place for the disposal of clinical and household waste and pest control. Staff said that they attended regular and compulsory fire and other health and safety training. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. The home had 2 staff trained as accredited manual handling trainers and there were hoists, and other equipment in the home to promote safe working practices. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 28 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(d) Requirement Timescale for action 31/12/06 2 OP7 15 3 OP29 19 The registered person must not provide accommodation to a service user unless, so far as it shall have been practicable to do so, he has confirmed in writing to the potential service user that having regard to the assessment by the home it is suitable to meet the individual’s needs in respect of his health and welfare. The registered person must 31/12/06 provided evidence of consultation with service users or their representatives in the preparation of their written plans of care. The registered person must not 31/10/06 allow any person to start working in the home until all the necessary pre-employment checks have been completed. Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Allenbrook Nursing Home DS0000064164.V307295.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!