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Inspection on 11/10/05 for Amesbury Abbey Nursing Home

Also see our care home review for Amesbury Abbey Nursing Home for more information

This inspection was carried out on 11th October 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Amesbury Abbey is set in its own extensive, attractive, well-maintained grounds. All rooms are large and many are in the form of apartments, with several rooms in each apartment. Clients are able to furnish their apartments themselves. The communal rooms are all large and furnished in accordance with the style of the building, all have wide views over the grounds. The nursing and care staff are supported by an extensive training programme, uptake of NVQ training is high. All clients have individualised care plans in place, these are detailed and are regularly evaluated. The home have put extensive work into meeting a range of requirements from the previous inspection by their due dates. Clients and their relatives were appreciative of the care provided. Of the fifteen clients who returned pre-inspection questionnaires, all said that staff treated them well and none said that they were not well cared for. One person wrote that staff are "very pleasant" and another said that staff treated them "very" well. One person spoken with said that staff are "terribly helpful", another described staff as "excellent" and another as "marvellous". One person said that "You couldn`t be anywhere better", another said "It`s lovely here" and another "they look after me very well". One person described the manager as "rather special" and said "she`s the reason I came here", another said that they could tell the deputy manager "anything and she`ll listen"

What has improved since the last inspection?

All of the thirteen requirements from the previous inspection had been addressed. All of the eight recommendations showed progress or had been addressed. At the follow-up inspection of 8 August 2005, one further requirement and a recommendation had been identified, these were addressed by this inspection. A full service users` guide is now freely available. All clients have documentation of their individual needs relating to prevention of pressure damage. All worn, stained and deteriorated carpets have been replaced and carpet joints made secure. A range of areas relating to maintenance of the home have been addressed. All parts of the flooring in the kitchen are now clean. Plans are in place to repair parts of the conservatory and to provide a third disabled bathing facility. A washer disinfector has been provided to ensure safe systems for prevention of spread of infection for sanitary items. An alarm system has been put on fire doors to alert staff if clients wander into these areas. Individual client risk assessments now include assessments for risks presented by unprotected hot surfaces. A review of the care needs for clients identified during the follow-up inspection of 8 August 2005 has taken place. All clients are now informed of what the choice is for lunch. The person responsible for manual handling is trained in her role. Where clients show complex behaviours, these are now monitored by a behaviour chart.

What the care home could do better:

The Abbey needs to ensure that where a client wishes to self-medicate that there is a full risk assessment drawn up. A hole in one carpet, which was identified during the inspection, must be repaired, as it could present a risk tripping injury to frail clients. Manual handling risk assessments should include an assessment of the client`s need for a variable height bed. Wording in all care plans and client documentation should be precise and measurable. Care plans which are developed as part of the evaluation process should be included in the main care plan documentation for easier access. The activities coordinator should attend an activities course to support her in her role. The process of naming/numbering clients` rooms should be continued. Concerns raised by clients or their relatives should be documented and regularly audited. The wall behind the washing machines in the laundry should be re-painted. An interview assessment tool should always be used when assessing prospective employees suitability for their role. Staff supervisions should be made in writing.

CARE HOMES FOR OLDER PEOPLE Amesbury Abbey Nursing Home Amesbury Wiltshire SP4 7EX Lead Inspector Susie Stratton Announced Inspection 11th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 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. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Amesbury Abbey Nursing Home Address Amesbury Wiltshire SP4 7EX 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) 01980 622957 01980 623767 Mrs Evelyn Mary Cornelius-Reid Mrs Esther Rose Thomas Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (2), Terminally ill (3) of places Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 3 persons in receipt of terminal care at any one time No more than 2 physically disabled residents at any one time No more than 50 service users over 65 years of age at any one time. Date of last inspection 11 April 2005 Brief Description of the Service: Amesbury Abbey provides care with nursing for up to fifty people. However, a number of rooms registered as doubles are often occupied as singles, this reduces occupancy levels to a more usual figure of around forty. Most of the rooms are in the form of apartments with their own bedroom and sitting room as well as a bathroom. The property is a listed building, set in extensive grounds. Accommodation is provided over three floors. The amenities of the small town of Amesbury are close by. Ample parking space is available on site and a bus stop is situated at the end of one of the drives. The home is close to the A303. The closest main line railway is in the city of Salisbury, about 20 minutes away. The home is part of a group of four establishments. The Registered Owner, Mrs M Cornelius-Reid, founded the group. She remains closely involved with all the homes. The registered manager for the home is Mrs Esther Thomas, she is supported by a deputy, Mrs Helen Collins and a team of nursing and care staff. Mr David Cornelius-Reid, site manager, manages the maintenance, housekeeping and administrative staff of the home, as well as acting as Mrs Cornelius-Reid’s deputy. Also situated within the grounds are Amesbury Abbey Mews. These provide sheltered accommodation for more able elderly people. The Mews is not part of the registered accommodation, and is not directly linked to the Abbey. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place Tuesday 11 October 2005 between 10:00am and 4:30pm in the presence of Mrs Esther Thomas, registered manager, Mrs Helen Collins, deputy manager and Mr David Cornelius-Reid site manager. The Inspector met with ten clients, two relatives and observed care for ten clients who were unable to communicate. The Inspector reviewed records for nine clients, toured the home, including the kitchen and the laundry and met with three carers, the training manager, two chefs and one domestic. The Inspector looked at a range of documents, including the files of three recently employed staff, medicines records, audits of care, maintenance records, training records and fire log book. Amesbury Abbey had two follow-up inspections following the previous inspection, one on 2 June 2005 and the other on 8 August 2005. By 8 August 2005, the home had met all requirements identified at the previous inspection by their due date. What the service does well: What has improved since the last inspection? Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 6 All of the thirteen requirements from the previous inspection had been addressed. All of the eight recommendations showed progress or had been addressed. At the follow-up inspection of 8 August 2005, one further requirement and a recommendation had been identified, these were addressed by this inspection. A full service users’ guide is now freely available. All clients have documentation of their individual needs relating to prevention of pressure damage. All worn, stained and deteriorated carpets have been replaced and carpet joints made secure. A range of areas relating to maintenance of the home have been addressed. All parts of the flooring in the kitchen are now clean. Plans are in place to repair parts of the conservatory and to provide a third disabled bathing facility. A washer disinfector has been provided to ensure safe systems for prevention of spread of infection for sanitary items. An alarm system has been put on fire doors to alert staff if clients wander into these areas. Individual client risk assessments now include assessments for risks presented by unprotected hot surfaces. A review of the care needs for clients identified during the follow-up inspection of 8 August 2005 has taken place. All clients are now informed of what the choice is for lunch. The person responsible for manual handling is trained in her role. Where clients show complex behaviours, these are now monitored by a behaviour chart. 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. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 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 Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 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): 1, 3, 4 & 5: 6:-Amesbury Abbey does not provide intermediate care. Amesbury Abbey has a service users’ guide which is available to all relevant persons to view. Prospective clients have a comprehensive pre-admission assessment. The Abbey is able to meet the range of needs of persons cared for in the home. Pre-admission visits are encouraged. EVIDENCE: A service users’ guide is available to all persons who wish to view it. The guide includes all relevant areas, including a copy of the most recent inspection report. An assessment is performed on all clients prior to admission. Assessments seen had been carried out in detail and were individualised, according to the prospective client’s needs. Where a full pre-admission assessment had not been possible, a brief assessment had been performed, this was followed by a detailed assessment of needs immediately after admission. Assessments are completed by the manager or her deputy, both of whom are experienced registered nurses. The Abbey provides care to a range of clients, all of whom have different needs. This inspection showed that the home were able to meet the range of needs presented by persons cared for in the home. Newly admitted clients said that they had been able to visit the home prior to admission and view their apartment prior to admission. They Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 9 also said that they had been enabled to make decisions about matters such as where to place their furniture and pictures before they came in, which made the settling in process easier. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 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, & 10 Clients in the home are supported by comprehensive nursing and care plans. These are highly individualised and regularly evaluated. The Abbey has an effective system for the management of medicines, but some clients could be put at risk by the lack of specific risk assessments when they wish to selfmedicate. Clients’ privacy and dignity are respected. EVIDENCE: Staff at Amesbury Abbey have put much work into developing a full care planning system for clients. All clients have a key worker who is responsible for drawing up and developing their care plan. All care plans are regularly reviewed and clients or their relatives are encouraged to be involved in agreeing to care plans, the majority of which had been signed by the client or their representative. All residents have risk assessments performed. These are individualised. For example, one resident had to be able to mobilise up and down a small flight of stairs, a clear risk assessment for this was in place, together with a care plan to direct staff on actions to take to ensure the client’s safety. Another client had a clear assessment and care plan relating to risk of falling, the care plan directed how the client’s safety was to be maintained, including the removal of Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 11 loose rugs and movable furniture between the clients bed and en-suite bathroom. All residents have very clear manual handling assessments and care plans, these are individualised. The Abbey is able to provide a range of variable height beds, however references to the need for such beds is not included in manual handling assessments, as is advised. Clients assessed as being at risk of pressure damage had clear care plans detailing how their individual risks were to be reduced. Frail clients care is monitored by use of a frequent care chart. Charts seen had been regularly completed. A comprehensive training package for staff in providing basic care has been developed by the training manager. The wording of most care plans and documentation was clear, however in a few cases imprecise wording such as “massive” or “assist” was observed and the manager was advised that wording used should be precise, describing what type of assistance a client needs. For example if the client needs assistance with their personal hygiene, the documentation should state whether the persons needs full help, can perform parts of their personal care or needs verbal support. Records show evidence of regular contact with clients’ GP and other relevant healthcare professionals. Records relating to wound care are clear and responses of wounds to treatments are regularly evaluated. None of the clients have sustained pressure damage. Records are in place relating to continence management and it is much to the credit of the home that only one client is assessed as needing a urinary catheter. Some care plans relating to, for example mental health care needs and social care needs, have been developed as part of the evaluation process. As the home regularly evaluates care, and such plans may become “lost” in paperwork. It is advisable that they be separate documents, so that all staff have ready access to directions on how to meet such care needs. All medicines were safety and correctly stored and all documentation fully completed. The Abbey has established a system for disposal of medications. which conforms to recent legislative changes. Several residents continue to self-medicate, this is reviewed regularly, however a risk assessment of client’s ability to self-medicate and to continue to do so is not carried out. This is required to ensure that if clients’ conditions do change that they can be safely supported in continuing to self-medicate until reviews of their risk assessment show the reasons why they are no longer able to do this. Al of the fifteen persons who returned comment cards said their privacy was respected, this was supported by clients spoken with. Staff of all levels were observed to consistently knock on doors and await a reply, prior to entry. Several clients commented particularly on the efficiency of the laundry service, that their own clothes were returned promptly to them and in a good condition. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Persons living in the Abbey are able to continue their own lifestyles. Activities are provided for persons who wish to participate. Clients are encouraged to go out of the home. The exercising of choice is supported by the ethos of the Abbey. A flexible meals service is offered and staff are able to support clients at mealtimes as needed. EVIDENCE: Amesbury Abbey has now established an activities programme, which is led by one of the staff. Clients spoken with said that it was up to them if they joined in. On the afternoon of the inspection, a music and movement class was taking place. Two residents told the Inspector how they particularly enjoyed the gardening group. The activities coordinator is enthusiastic and has gathered a range of materials to support her in her role, a course has been booked for her to attend and the manager continues to look at a range of options to support her in her role. Some clients are happy to find their own activities, three were sitting chatting together in the library during the afternoon and one said that they went out to friends in the mews every afternoon. Of the fifteen persons who completed the pre-inspection questionnaire, only one said that the Abbey did not provide suitable activities. This shows how much the home has developed in this area during the past year. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 13 Clients are encouraged to go out of the home is they wish. Several said they went out regularly with their families and friends. One client was away on holiday at the time of the inspection and another had only recently returned from holiday. Clients who wish to can go to the local church, which is just at the end of the drive, on Sundays. Larger group activities are also organised, either out of the home or in the home. Several clients said how much they had enjoyed a recent evening musical event. Persons spoken to said that it was up to them as to how they spent their day. One person said that staff had learnt to know when they liked to go to bed and that they no longer had to ask, staff just came at the right time. One client was spending the morning in bed, as that was what they wished to do. Persons in the home can go down for meals or have them in their room, according to what they wanted to do, one person said that they had an appointment that afternoon and so had asked to have their lunch early in their room and all they had had to do was to mention this to the carer in the morning to ensure that this took place. Following requests from clients, all staff have been provided with clear name badges. Three clients said that they found it much easier now that they knew the names of their carers and could call them by their proper name. At previous inspections, several clients have said that they would like to have bedrooms labelled with their name/number or other means of identification. Two rooms are named. One client said that they thought this was a “good move” and hoped that it would be spread across the home. Meals are provided in a dining room on the ground floor or clients can eat in their own room, if that is what they want. Meals are attractively served, some clients recently asked for their vegetables not to be served up on their plates as they wished to be able to serve themselves from dishes on the table and this had taken place. Where clients do not like the meal, the Abbey is able to provide a range of alternatives. Staff are available at mealtimes to support and assist clients as needed. Several clients commented particularly on the flexibility of the evening meal and that they could have a larger or smaller portion according to how they were feeling that day. The chef showed a personal knowledge of clients and their preferences. Of the fifteen persons who returned the pre-inspection questionnaire only one said that they did not like the food, this is a good result for a home catering for such a large number of persons and shows how hard the home work to meet clients’ preferences. One client spoken with described the meals as “very good” and said “I’m frightened of getting fat.” Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Amesbury Abbey has a complaints procedure, which clients spoken with felt worked in practice. Clients as protected from abuse by staff training and procedures in the home. EVIDENCE: Amesbury Abbey has a full complaints procedure, which is made available to clients and their relatives. Thirteen of the fifteen persons who completed preinspection questionnaires said they knew who to go to if they were unhappy about their care. Clients spoken with were all very confident that they could raise issues with staff and that if they were not resolved that they could go to the deputy manager or manager. During the inspection, one client complained about response time when they used their call bell, this was promptly investigated by the deputy manager. The home does not keep a record of concerns raised by clients or their relatives and actions taken. Some such records are documented in clients’ notes, but not on every occasion. As part of the Abbey’s quality audit systems, these concerns should be documented, so that managers can assure themselves that they are aware of all issues of importance to clients and that all staff have consistently addressed matters when they have been raised. Of the fourteen clients who completed that part of the pre-inspection questionnaire, all said they felt safe in the Abbey. Training in abuse awareness is provided on induction and regularly thereafter. It was noted as good practice that the home uses very few safety rails on clients’ beds and as much as possible uses alternative systems to ensure clients’ safety. Where bed rails are used, the need for use of such rails is regularly evaluated. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26 Amesbury Abbey presents a comfortable and clean environment for clients. Most of the home is well generally maintained and many improvements have been put into facilities and equipment provision since the previous inspection. One area of maintenance only was identified at this inspection. EVIDENCE: Amesbury Abbey is a large building, which due to its age and size needs regular maintenance. A full team of maintenance staff is employed. A maintenance request system is in place for small repairs. It is regularly reviewed by the maintenance manager. Many of the corridor carpets have been replaced since the last inspection and these areas of the home presents a more attractive atmosphere than at previous inspections. Some of the other carpets are getting older and will need to be replaced in due course. One corridor carpet which was identified during the inspection, showed a hole, which could present a risk of tripping injury to frail clients or those with a shuffling gait. A new chef has been employed since the previous inspection and the kitchen now presents a much cleaner and more organised atmosphere. The linoleum floor is cracking in some places and an action plan is in place to Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 16 replace the flooring. The cracks in the flooring at this inspection were all noted to be free of debris. All service users rent apartments in the home, some of them are large with a hall, sitting room, bedroom and bathroom. Smaller rooms all exceed minimum standards. Service users furnish their own rooms, this means that they are all highly individual in style. One client described their room as “lovely”. There is a drawing room, dining room and conservatory and several service users also like to sit in the entrance hall, which is provided with comfortable furniture. The Abbey had extensive grounds and nearly all room windows have very attractive views. Improvements have been made to communal bathing facilities for disabled persons. The Parker bath on the ground floor is due to be replaced at the end of the month. A disabled shower on the first floor is functional but needs some repair to its door, this has been booked to take place. The bathroom on the second floor is to be replaced by a disabled shower at the end of October and a ramp provided to the single step in the corridor outside the bathroom. When these works have been completed, disabled bathing facilities will be available to clients on every floor of the home. A range of equipment is provided to meet clients’ needs. New hand rails have been provided to corridor areas by the first floor bathroom. A range of hoists and other aids to manual handling are provided. Staff were observed to be competent in their use. Frail clients have pressure relieving equipment. A range of variable height beds are provided. All of the home was clean throughout, this included sanitary aids, underneath beds and in bathrooms. A new washer disinfector has been provided in the sluice room on the ground floor. This will much improve standards for the prevention of spread of infection in the home. The sluice room itself was clean and well organised. The home’s laundry was clean and tidy, a new industrial washing machine has been provided since the previous inspection. The area of wall behind the washing machines was beginning to show flaking paint and so the wall is beginning not to present a wipable service. The wall should be repainted before its condition deteriorates. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 & 30 Amesbury Abbey maintains staffing levels to meet clients’ needs. Clients are supported by trained staff and staff are encouraged and supported in extending their skills. EVIDENCE: Amesbury Abbey have Conditions of Registration setting minimum staffing levels from which they must not regress. They are meeting the condition. The Abbey is staffed by a core of staff who have been employed for a period of time, other staff come from aboard or are related to army personnel and so may change from time to time. Where staff’s first language is not English, they are not employed until they have passed an English language test. Training is encouraged and one member of staff leads on training and development. She keeps clear and comprehensive records of training provided to staff during the year. Records show that a wide variety of training has been offered to staff and that NVQ 2 up-take by staff is over 50 . The files of three recently employed members of staff showed that all required pre-employment checks take place, including proof of identity, two references and full application form. All staff have CRB and pova checks prior to employment and evidence of work permits are available on files of staff employed from abroad. Staff are interviewed for their post but an interview assessment is not consistently completed, as is advised, to identify individuals strengths and weaknesses. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 36 & 38 : 35:- the Abbey does not look after client’s moneys. The home is managed by an experienced manager and registered nurse. Regular systems of for auditing the quality of care are in place. There are systems for staff supervision, although improvements should be made to documentation relating to this. The health and safety of clients is promoted. EVIDENCE: The manager has recently completed an external academic qualification in stroke rehabilitation. She is now going on to looking at taking the registered managers award. Mrs Thomas is an experienced manager and registered nurse, she is supported by Mrs Collins, her deputy who is also an experienced registered nurse and manager. The manager regularly audits a range of areas to ensure clients’ needs are met, these include reviews of accidents, visits by clients to Accident and Emergency departments, response times when the nurse call bell is used, infection rates, views on service provision and the like. There was evidence that when clients raise issues or care practice needs development, that they are addressed. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 19 All staff receive a full and structured induction to support them when they commence their duties. Records are fully maintained and there was evidence of supervision by the training manager for new employees throughout the induction period. Files showed that all staff receive and annual appraisal and that when training needs are identified during supervision that action is taken to meet these needs. Discussions with staff and reviews of systems indicated that supervision clearly takes place but there is no systematic system for documenting this. This should now take place to evidence all the work that has been put forward in their area. The maintenance manager is responsible for ensuring that all relevant checks on equipment and services take place, he maintains clear and comprehensive records. Environmental risk assessments across the home have recently been reviewed and revised. The fire log book is full maintained as required. The training manager has produced a clear training pack to support staff in learning about first aid. All staff working in the kitchen have been trained in basic food handling or above. Not all radiators are covered, where they are not, clear risk assessments are in place, these are regularly reviewed. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 20 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A 3 x 3 Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 21 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. 2. Standard OP9 OP19 Regulation 13(2) 13(3)(a) (c) Requirement Where a service user wishes to self-medicate, a full risk assessment must be drawn up The hole in the carpet, which was identified during the inspection, must be repaired. Timescale for action 31/12/05 30/11/05 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. 3. 4. Refer to Standard OP7 OP7 OP7 OP12 Good Practice Recommendations Manual handling risk assessments should include a written assessment of the service user’s need for a variable height bed. Wording in care plans and other service user documentation should be precise and measurable. The use of generalisitc wording should be avoided. Care plans developed as part of the evaluation process should be included in the service user’s main care plan documentation, for easier access. The activities coordinator should attend an activities course to support her in her role. (This was identified at the past three inspections. Plans are in place for DS0000015885.V252434.R01.S.doc Version 5.0 Page 22 Amesbury Abbey Nursing Home 5. OP14 6. OP16 7. 8. OP26 OP29 9. OP36 this to be actioned in the future). The process of naming/numbering of service users’ apartments should be continued. (This recommendation has been identified for the past three inspections and shows limited action). Concerns raised by service users or their supporters should be documented. These should be regularly audited to assess issues and response(s) by staff. (This recommendation was identified at the previous inspection and shows some development). The wall behind the washing machines in the laundry should be re-painted to provide a wipeable surface, before it deteriorates further. An interview assessment tool should be used when assessing prospective employee’s suitability for their role.(This recommendation was identified at the inspection of 6 January 2005 but had not been consistently addressed). All staff supervisions should be made in writing and a record maintained in the home’s files. Amesbury Abbey Nursing Home DS0000015885.V252434.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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