Inspection on 13/04/07 for Amesbury Abbey Nursing Home

This inspection was carried out on 13th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

Other inspections for this house

Amesbury Abbey Nursing Home 10/02/09

Amesbury Abbey Nursing Home 18/05/06

Amesbury Abbey Nursing Home 11/10/05

Amesbury Abbey Nursing Home 11/04/05

Amesbury Abbey Nursing Home 06/01/05

Amesbury Abbey Nursing Home 21/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Amesbury Abbey Nursing Home Amesbury Wiltshire SP4 7EX Lead Inspector Susie Stratton Unannounced Inspection 9:25 13th April & 3rd May 2007 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.V332452.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. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 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 dcr@the-abbey-group.ssnet.co.uk 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.V332452.R01.S.doc Version 5.2 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 18th May 2006 Brief Description of the Service: Amesbury Abbey provides care with nursing for up to fifty older people. However, as a number of rooms registered as doubles are often occupied as singles, this reduces occupancy levels to a more usual figure of around forty. On the day of the first site visit, there were 37 persons living in the home and four vacant rooms. 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, with passenger lifts in between. The small town of Amesbury is 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. Amesbury Abbey is part of a group of four care homes. 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 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. A deposit is required for all apartments, deposits range from £15,000 for a bed sitting room to £25,000 for a roomed apartment. The fee range is then from £2895 per month to £3920 per month, depending on the size of apartment rented. Items not included in the fees are hairdressing, chiropody, visitor’s meals, newspapers and sundries. A copy of the service user’s guide is provided in each resident’s apartment and is also available in the main entrance hall. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 36 questionnaires were sent out and 15 were returned. Comments made by residents and their relatives in questionnaires and during the inspection have been included when drawing up the report. The home also provided information requested by the CSCI prior to the inspection, relating to policies, residents and staff. As Amesbury Abbey is a larger registration, the site visits took place over two days, on Friday 13th April 2007 between 9:25am and 4:10pm and Thursday 3rd May 2007 between 9:25am and 2:30pm. The first site visit was unannounced. The registered manager, Mrs Esther Thomas, was on duty for both the site visits. During the site visits, the inspector met with eighteen residents, and observed care for nine further residents for whom communication was difficult. The Inspector reviewed care provision and documentation in detail for six residents, three of whom had recently been admitted. The relatives of these residents were sent surveys, to gain their opinion of the quality of care provided. As well as meeting with residents and visitors, the inspector met with three registered nurses, three carers, the site manager, the hotel services manager (who is also a chef), a housekeeper, a waitress, two laundresses, the maintenance man, the activities coordinator, the training manager and an administrator. The inspector toured all the building and observed a lunch-time meal and a medicines round. Systems for administration of medicines and the clinical room was inspected. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service 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. All rooms, even the smallest, much exceed national minimum standards. Service users furnish their apartments themselves. The drawing room is large and furnished in accordance with the style of the building, it has wide views over the grounds. The home has effective working relationships with local healthcare services. Registered nurses are aware of current research-based evidence in meeting healthcare needs, particularly in relation to terminal care, continence care, wound care Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 6 and diabetic care. Visitors are actively encouraged and family, friends and members of the local community are supported in coming into the home. People expressed their appreciation of the home, one said “No home can be perfect but I think that this one is as good as one can reasonably hope to get”, another “This is an outstanding home and it really is a home, particularly for the really poorly when staff come into their own” and another “I can’t see how anyone could be anything other than happy here.” People also said how supportive the staff were, one said “The staff are marvellous”, another “They are extremely attentive”, another “There’s nothing they cannot do for you”, another “I’m in good hands here” and another “They do understand.” One relative commented “I think it’s an excellent establishment. I know some of the pressures they’re under and think they manage these extremely well. What has improved since the last inspection? Eleven requirements and seven good practice recommendations were made at the previous inspection. Ten of the requirements had been addressed in full and one showed progress. All of the recommendations had been addressed. All people are now given their own copy of the service users’ guide. The home ensures that it only cares for service users as specified in their Conditions of Registration. Where a vulnerable adult is at risk, staff are aware that they must be promptly referred to appropriate authorities in accordance with local safeguarding adults procedures. Since the last inspection, the home has been informing the Commission of all events which could seriously affect the wellbeing of service users. Improved systems have been put in for the recording of complaints in some departments. Where items are handed in for safekeeping the descriptions of these items are now more precise. The registered manager and her staff have been developing their practice for people with terminal illness, to the extent where she and her staff have been asked to present their developments at a regional conference. Where evaluations or other information shows that resident’ care needs have changed, their care plan is now always promptly up-dated. Where people are prescribed drugs which can affect their activities of daily living, this is now included in their care plans, to further develop and improve monitoring systems. The home has further extended and developed activities, particularly for frail people or those with dual care needs. The registered manager has commenced Registered Managers training. Staff who have contact with residents, including domestic, catering and maintenance staff have been trained in abuse awareness. An interview assessment tool is now used when assessing prospective employee’s suitability for their role. The induction programme for registered nurses and ancillary staff has been much developed. All clinical supervisions for registered nurses are now made in writing. Waitress staff have been trained in manual handling. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 7 The bathroom on the ground floor has been provided with improved heating. The damaged areas in the wall around the clinical hand wash basin at the nurses’ station have been repaired, to provide a wipeable surface. The home have ensured that there are safe systems, which conforms to fire safety policy, for exiting one area of the home. What they could do better: Ten requirements and eight good practice recommendations were made at this inspection. To fully inform potential residents and their supporters, the home’s statement of purpose and service users’ guide must be up-dated and revised, to reflect current service provision. Both documents need to agree in all areas. The service users’ guide must include a copy of the summary of the inspection report, together with information on how a full copy of the report is to be obtained. The home’s contracts must be revised to reflect regulations relating to information about fees in homes where nursing is provided. The home needs to ensure that clear records of all complaints, including verbal complaints, are made together with investigations into the matter, outcomes and actions taken. This requirement was identified at the previous inspection with a compliance date of 16/7/06. It has been addressed in part but not for all areas, such as complaints about meals or maintenance. All employees need to have full details of their employment history or gaps in employment recorded. All senior managers and staff who have responsibility for resident finances should be trained in abuse awareness, including the local Wiltshire policy. Where a person is assessed as having a risk, a written plan must always be put in place to direct staff on how their risk is to be reduced. To support registered nurses and residents, the policy and procedure on administration of medicines needs to be revised and up-dated, to reflect current practice. The activities coordinator or her assistants should be given time to complete personal profiles on all residents. The kitchen floor must be repaired, to present an intact, cleanable surface. Staff must be advised of their individual responsibilities for reporting on issues which could have the potential to affect the health and safety of any persons. To protect staff, relatives and residents, a risk assessment needs to completed in relation to persons pushing wheelchairs over grassed areas. If risk is identified, an action plan needs to be put in place to address the risk. To ensure that equipment is correctly in place and fully functioning, responsibilities for performing monthly checks on the safety of bed safety rails must be clarified. As several people have commented that the dining room can become cramped and hot when full, the home needs to consider how dining facilities can be improved. All stained carpets should be replaced. All deteriorated corridor areas should be improved and cob-webs removed. Attention needs to be paid to the walls below the soap dispensers in communal bathrooms, before they Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 8 deteriorate further. The manager should have ready access to a suitable room to hold meetings with people, particularly where persons with terminal care conditions are being cared for. Consideration should be given to providing a larger staff changing area and a showering facility. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. The home does not admit persons for intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Prospective residents and their supporters are provided with information about the Abbey but the information provided needs reviewing and further developing to reflect the services currently provided. This will fully inform people about all services provided, to enable them to make a decision about admission. Contracts for residents need revision, to reflect current regulations relating to homes which provide nursing. The home performs very detailed pre-admission assessments of prospective residents’ nursing and care needs, ensuring that as much as possible all that key information on their nursing and care needs is available, prior to admission. Prospective residents or their supporters are actively encouraged to visit the home prior to admission. EVIDENCE: Of the twelve people who responded to this part of the questionnaires, ten reported that they had received enough information about services provided, Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 11 to enable them to make a decision about being admitted. Two reported that they had not. One person described the information received as “confusing”. One person reported, “I came here because it was enthusiastically recommended by a person who knew it well.” Prospective residents are informed about the services provided in the service users’ guide, a copy of which is made available in each person’s room. The home’s statement of purpose was drawn up before the service users’ guide and needs revision, so that it conforms to regulations and reflects all areas detailed in the service users’ guide. For example the statement of purpose does not detail the range of services offered by the home to care for persons with terminal conditions, it also does not specify that the home environment is not suitable for persons who present with complex challenging behaviours. The statement of purpose does include an organisational structure, but this needs revision, as it does not detail the hotel services manager or site manager, or where they fit into the structure, their accountability and who is accountable to them. With changes in legislation about smoking, the information needs to detail the Abbey’s position on smoking. People need to be informed about the current situation about the conservatory and whether is it to be used as a resident area. The service users guide and statement of purpose contain different complaints procedures, which do not reflect the procedure in the main file. The Abbey has recently developed clear systems for when residents wish to self-medicate. The information does not reflect the good practice shown by the Abbey in this area. The service users guide provided to people in their rooms does not include a copy of the summary of the most recent inspection report and this is required to inform residents and their supporters of the home’s response to inspection. The home’s contracts were reviewed. Each person is supplied with a very detailed contract, which they or their representative signs and dates. Contracts include significant matters such as fees payable in the event of admission to hospital or death. If a person changes their accommodation within the home, they are issued with a revised contract. Revisions to regulations relating to homes which provide nursing were discussed with the site manager and he was advised that current contracts will need revision, to ensure that they conform to Regulations relating to information about fees charged and funded nursing contributions. These regulations have been put in place to protect people who use the service and their supporters. The inspector met with three persons who had recently been admitted. They all reported on how they had been supported by their families in deciding on admission. Some of them had been able to visit the Abbey prior to admission, to view their room, meet with staff and look round the home. Mrs Thomas reported that pre-admission visits are encouraged and were found by her staff to be very useful in supporting the “settling in” process for any new resident. Where a person was too frail to come to the home, the manager or her deputy Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 12 goes to meet them, if they were living at a reasonable distance from the Abbey. If they were further away, telephone assessments are performed. All three people met with had detailed pre-admission assessments completed either before or at admission. For one person, there was very limited information available from their previous provider, despite the manager going to meet the person in their previous placement, so the manager had ensured that full and detailed assessment of their needs had taken place at admission. One person had been admitted from abroad and a review of their records showed that a full telephone assessment of their needs had taken place before admission and that relevant medical records had been translated into English and reviewed, before the manager made the decision that they could meet the person’s needs. One person had a wound, which needed regular dressing. Full details of treatments for this wound had been obtained from their district nurse before admission. Assessments reflected in full what was observed, what people reported and what staff said. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are nearly always protected by detailed assessments and care plans, which direct staff on actions to take. Residents are protected by the home’s monitoring systems and close working relationships with healthcare professionals. There are safe systems for administration of medicines although registered nurses would be further supported by up-dating of the policy and procedure on administration of medicines. Residents’ privacy and dignity is respected by staff at all levels. EVIDENCE: All people cared for have full and detailed plans of care. These are evaluated monthly or when the person’s nursing or care needs change. All people are regularly assessed for risk, including risk of pressure damage, dietary risk and manual handling. Where a risk is identified, care plans are nearly always in place to direct staff on how risk is to be reduced. For one person whose dietary risk had recently increased, a care plan had not been drawn up to Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 14 direct staff on how risk was to be reduced. This is needed as the person was assessed as being at high nutritional risk. Discussions with staff and a review of the resident care in practice indicated that their increased nursing needs were being met. Care plans were clear and reflected what both residents and staff reported. Care plans were readily available to staff. For example all people who needed the application of topical creams and lotions had plans placed in their en-suites to inform staff of which application was to be used and where. Residents’ manual handling care plans were also available in all service users’ rooms. These were regularly evaluated. Where people needed thickening agents to assist them in swallowing, care plans had been drawn up. By the second day of the inspection, the amount of thickening agent needed or preferred by person was documented in every case. Where frail residents needed their positions changing regularly or to be offered fluids and food, each person had a monitoring system. A review of records showed that charts were fully completed in accordance with directives in care plans. The amount of fluids taken in every day was totalled and where risk of dehydration was increasing, this was noted and action taken to support the resident. Where people needed dietary supplements, there were full records to show that they were being given such supplements. Some of the residents have mental health needs, as well as general care needs. Where this was the case, they had care plans to direct staff on how such needs were to be managed. It is much to the home’s credit that very few mood-altering drugs are used to manage such behaviours. Where residents’ mental health needs begin to outweigh their physical care needs, reassessments take place and prompt referral is made to relevant medial support. Since the previous inspection, the manger has set up a system whereby an early case conference takes place, involving the relatives, so that they can be advised of the resident’s changing needs at an early stage and consideration given to whether the Abbey continues to be the correct placement for the resident. This had taken place for one person since the previous inspection and alternative placements were being considered. The Abbey has effective working relationships with the local GP services. They also have a system to ensure that all persons are reviewed by their GPs on a regular basis. Thirteen of the fifteen people who responded to that part of the questionnaire reported that they always received the medical support that they needed and two that they usually did. The home also refers persons to relevant external health care professionals as needed. The hearing aid therapist was visiting the home at the time of the first site visit, one person was being visited by a Macmillan Nurse and there was evidence of recent visits from the speech and language therapist. Where residents have wounds, the deputy manager leads the nursing team on tissue viability. There are very clear care plans and monitoring systems for wounds. One person reported Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 15 “She did me more good than anybody” about the deputy manager’s treatment programme for their wound. Another person reported that their wound had improved greatly since their admission to the home and that their dressing always stayed in place, which it had not done when they were at home. Where the home cares for insulin dependant diabetics, there are clear systems for monitoring of the person’s condition and evidence of regular contact with their GP when indicated. Staff maintain close working relationships with the local continence advisor and urinary catheters are used only where there are strong clinical indicators for their use. The home has clear systems for administration of medicines. One medicine administration round was observed and the registered nurse was noted to perform the medicines round in a safe manner, in accordance with Nursing and Midwifery Council Guidelines. She reported that registered nurses were all regularly trained in the safe administration of medicines by a qualified person from the local Primary Care Trust. Full records of medicines were maintained, including Controlled Drugs. All prescribed items stored were within their expiry dates. Self medication is actively encouraged. Where residents do selfmedicate, risk assessment are drawn up, which are reviewed regularly. The registered nurse was aware of one person whose needs were changing and that a review of their risk assessment had indicated that they were finding managing their own medication increasingly complex and she was aware of the steps being taken to support the person. All persons who have been prescribed drugs which could affect their daily lives had care plans in place, so that staff can inform their GPs of the effectiveness of treatment. The Abbey has a range of information to support staff on safe administration of medicines. This needs developing into a full medicines administration policy and procedure, to inform all registered nurses of the standards expected by the home. All personal care was performed behind closed doors. The laundresses regarded ensuring that residents’ own clothes were returned to them in a prompt and well presented manner, as part of their role. Although some of the residents had care needs relating to incontinence, it was noted as good practice that no unpleasant odours were noticeable in any of their rooms. During the inspection, one frail resident was observed to become confused and anxious. This was promptly noted by a registered nurse, who attended to the resident and carefully and quietly explained a different way to approach a situation, supporting the resident and helping them to become more calm, and understand what was actually happening. One relative reported “They respect the dignity of residents” and another “All members of staff seem very kind and respectful to the people they’re caring for”. Some relatives commented on how supportive staff were to frail persons, one commented “The more frail [this person] became, the more care ….. received”. One person said “I’m looked after so well”. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home works hard to ensure that residents’ diverse recreational and spiritual needs are met. Residents are supported in maintaining close links with their families and local services. People are helped to exercise choice. Residents are given a balanced diet, in reasonable surroundings. EVIDENCE: The Abbey have put extensive efforts into developing an activities programme for residents during the past few years. A programme of events is distributed to all residents every week and people can join in activities as they wish. Activities are offered six days a week. Several residents reported that they had enjoyed a recent cooking session making chocolate cakes. One resident reported on how much they enjoyed the games of Scrabble. One person reported “Activities are arranged by a nurse who takes an enthusiastic interest in entertaining the residents and does it very well” another reported “I used to enjoy it but I am rather too old now”. One newly admitted person said that they had already made friends in the home. Many of the residents are able to access their own activities and people are supported in going into the local Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 17 town. Several people commented on the beauties of the grounds. One person said that they went out into the grounds every day unless it was raining. People commented on the close links with the local church, which is situated at the end of one of the drives. People reported that they were made to feel welcome by the congregation. One person said that the local vicar “does an excellent service here every Sunday and we all like him.” The home also cares for a few Roman Catholics and the priest visits the home regularly to offer Communion. No persons from any other religions or ethnic groups are currently cared for. The activities coordinator was very enthusiastic in her role. She has developed a range of activities suitable for residents; particularly those who need additional support, due to dual care needs. She meets all new residents and their families, to find out what their hobbies and interests are. Where residents wish to be involved in group activities she is happy to arrange these. Where a resident does not wish to leave their room, she can arrange individual support in their rooms. Where residents have particular interests, for example one person wanted to do to the cinema, she arranged this. A range of outings have been provided during the past year, she reported on a barge trip, during the previous summer, which they are planning to repeat this year as it had been so popular. Other residents prefer shorter trips, for example to a garden centre. She has begun developing very detailed personal profiles for individual residents, to support staff in ensuring that apparently small, but very significant details for a resident are met, such as preferences for the colour of nail varnish, that the person dislikes news programmes or wishes to follow a particular sport. She is to be congratulated for this innovation and needs support in being able to develop personal profiles for all people currently in the home, to ensure that they staff are fully informed of what how residents wish to live their lives. The activities coordinator has also been actively involved in developing supports to people with a terminal illness. Relatives can come and go as they wish. Several relatives were visiting at the time of the inspection. One was bringing in their dog with them, which their relative clearly enjoyed. One family member commented “In fact the care and attention given to ….. (& family) was quite outstanding – phenomenal. This is what the staff on all levels – do so well.” Staff also understand the importance of other “family” members. Mrs Thomas was working hard at the time of the first site visit to ensure that a person’s dog, who had been with them for many years, could also come into the home.. If the kitchen are given warning, relatives can eat a meal with the resident when they visit. People said that they were able to choose how they spent their days and could get up and go to bed when they wanted. One person was attending an outpatient appointment at the time of the inspection and had chosen not to have a member of staff with them, requesting transport from the home only. One person reported on how they had negotiated a particular aspect of their Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 18 care plan with the nursing staff, to ensure that they could continue their life as they wanted to, but in safety and under the supervision of staff. Two residents had moved rooms recently, at their own request, so that they could have a room in an area of the home which they felt would suit them better. All people reported that they could choose their meals. One person said “If I want an omelette, I just ask and I get one”, another said “I like having my supper given to me on a tray” A wide range of comments were made about the meals. Of the ten persons who responded to that part of the questionnaire, one said they always, six that they usually and three that they sometimes liked the meals. Comments varied from describing the meals as “terrible”, through “not very good”, “fine” to “wonderful”. People commented on different meals, some described the meat as “tough”, some said they wanted more green vegetables, one person said how much they liked the roast beef and another that they enjoyed the ice creams. Meals can be eaten in the main dining room or the residents’ room, as they prefer. Several people commented that the dining room was “too cramped” when most people were eating there, especially if relatives were eating meals with residents. One reported that the room was also “too hot” when it was full. This was reflected in the home’s own surveys of residents’ opinions about the home’s service provision. This has been noted at previous inspections and needs to be considered by the home managers. Meals are served by waitresses in the dining room and a discussion with them showed they had a flexible approach. One described how they were aware of the importance of plating up meals individually, to meet what each person wanted, saying that where a person had a poor appetite, they took care to make sure that the meal was presented nicely and that the person was not put off eating, by giving them too much food on their plate. One person reported “a great deal of trouble is taken over the presentation”. Where residents eat in their own rooms, meals are hot when they leave the kitchen and a carer reported that they had a microwave on each floor so that if any meal becomes cooler in transit, they can quickly heat it up again. Liquidised meals were attractively presented and attention given to appearance on the plate. The staff showed an awareness of special diets and there was a large laminated information sheet available, to inform staff about the carbohydrate content of different ingredients. This ensures that residents who have diabetic conditions, those on weight reduction diets and those on weight increasing diets are given meals which suit their medical needs. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People reported that they were confident that their complaints would be listened to and action taken when needed. The home continues not do document all complaints, so managers would not have an overview of all aspects of what was concerning people. The home has systems in place to protect persons from risk of abuse. EVIDENCE: The home has a complaints procedure. The home manager completes clear records of matters relating to nursing and care and other matters reported to her or her staff. Of the fifteen people who responded to the questionnaire, thirteen reported that they knew how to make a complaint. One person reported, “If I’m not happy with something, I talk to [Mrs Thomas], she’s the person who understands.” One person reported that Mrs Thomas “knows and has followed it up”, about a certain matter. Two people reported that they did not have any complaints and one person when asked if they ever complained stated “and I do”. Relatives made similar comments, one reported “Staff have always given time, particularly to families, to listen to and act on, concerns” another relative reported “any concerns raised about physical well-being and care are promptly attended to”. All staff spoken with knew how to report complaints. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 20 Some people reported that if they did not like the meals, they reported this directly to the hotel services manager. One said, “I talk to ……… if I don’t like the food”. On discussion with the hotel services manager, he clearly takes much time and effort into listening to what people have to say about meals and trying to address their concerns. All matters reported to the inspector during the inspection were already known about by the hotel service manager. He does not document these concerns and he was advised that he needs to do so, so that he and senior managers had a record of issues raised and how they had been addressed. Two relatives reported that they had raised issues about maintenance. Staff reported that issues, including complaints relating to maintenance were documented on the day-to-day maintenance log. Such complaints are not logged centrally. It was discussed that all complaints need to be documented and records of complaints be regularly reviewed to identify actions taken and trends. All staff spoken with showed a full awareness of the importance of safeguarding adults. The manager also has experience of working within local safeguarding adults procedures. She reported that she and some of her more senior staff had recently attended study days relating to this matter and found it interesting and thought-provoking. The training manager has attended a course to enable her to train others in abuse awareness. She has a range of training materials, including distance learning packs, which she uses when training staff. All staff are trained in abuse awareness on induction. Nearly all staff employed in the home, including ancillary staff, have now been trained and the training manager has plans in place to train the last few staff who have not yet received training. Some of the senior managers and one of the administrators need training in the local procedure as they may need to alert the local safeguarding adults team, if Mrs Thomas or her deputy are not available. Where residents need restraints such as safety rails, this is fully documented, with risk assessments being performed in every case. These are regularly evaluated. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Parts of the Abbey are well-maintained but some communal areas and the kitchen would benefit from attention to specific matters. People have access to a range of indoor and outdoor communal facilities. A wide range of equipment for disabled people is available. The home shows high standards in the prevention of spread of infection. EVIDENCE: Amesbury Abbey is a large building, which due to its age and size needs regular maintenance. One person reported “Some painting needs doing to the ceiling” another “Old building needing everything from plumbing up”. One relative reported “My only grumble is the management sometimes do not act on requirements quickly re apartment issues e.g. decoration, lighting, fixtures & fittings etc” and another “Occasionally, it is necessary to chase matters Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 22 concerning maintenance.” People reported on the helpfulness of the maintenance staff, one described how the carpenters had worked on their wardrobe door the day before and another said “Excellent electrician and handyman”. At the time of the site visits, due to a leak in the roof, some areas in parts of the home showed damage to walls and cleanings. Mrs Thomas reported that they were awaiting full drying of these areas, prior to redecoration. Some of the public areas were well-presented, but this was not the case for all areas. Some of the smaller corrdors leading to rooms needed attention to paint-work, with scrapes along walls, doors and skirting boards. Cobwebs were visible in corners on the ceilings. Several of the carpets were stained. This was discussed with staff, who reported that carpets were frequently cleaned but, due to their age and types of staining, not all marking could be removed. The site manager reported that he was developing plans to replace the affected carpets. Attention is needed to the kitchen. There is a large crack in the flooring in the area between the preparation and cooking areas. At the time of both site visits, it showed development of debris, with some accumulation beginning to lift the flooring in some areas. A similar issue was identified at the inspection of 10/11/05 and it was noted that an action plan was in place to improve the kitchen flooring. By the inspection of 18/5/06, the area had been fully cleaned, however this improvement has not been sustained and issues were again noted at this inspection. Some tiles by the wash up area needed attention to the grouting. The environmental health department have been informed of the situation. All parts of the kitchen need to be intact and wipeable, to ensure high standards of cleanliness. The manager reported that they were planning to replace the kitchen flooring within six months. All persons rent apartments in the home, some of them are large with a hall, sitting room, bedroom and bathroom. Smaller rooms all exceed minimum standards. Residents furnish their own rooms, this means that they are all highly individual in style. There is a drawing room, dining room and several persons also like to sit in the entrance hall, which is provided with comfortable furniture. There is a conservatory but it is not much used as it was reported to need up-grading. As some residents commented that they liked this area and felt that it needed to be used, the current situation needs to be clarified in the home’s service users’ guide. The Abbey has extensive grounds and nearly all room windows have very attractive views. One person reported “I would like to mention the grounds which are absolutely beautiful”, another “Wonderful grounds”, another “I’ve got a very good view” and one person commented particularly on how they liked to watch the rabbits on the lawns in the early mornings. The registered manager has a small office, which is also the nurses’ station. It can only provide seating for a few people, so if she needs to hold larger meetings, for example with family members, all people either have to crowd into this room or the drawing room has to be used, this will take it out of use for residents. The manager’s office is difficult to take out of use for an extended meeting as all residents’ records are held there and staff may need Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 23 access. It is recommended, particularly now that the Abbey has gained such local expertise in caring for persons with a terminal illness, that a more private space is provided elsewhere in this large building, where the manager can meet with relatives and support staff when needed. Staff have a small changing facility on the ground floor. It is too small for all staff on a shift to change in at once or for all staff to leave their uniform and shoes between duties. Currently the room has been affected by the ceiling leak noted above, so much of the wall covering is coming off. There are no facilities for staff to shower after being on duty and this is highly recommended as the Abbey may care for persons who have an infection. The Abbey has much improved its bathing facilities for service users over the past few years and full disabled bathing facilities are now available on every floor of the home. The Parker bathroom had had its heating improved since the last inspection. The walls under the soap dispensers in the bathrooms were beginning to deteriorate, with visible staining. Attention needs to be given to these areas before they deteriorate further. Equipment is provided to meet service users’ disability needs. 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. Most beds are re-conditioned and there are few profiling beds. Service users are all left with access to their call bells and reported that staff attended promptly when they used them. One person said “If I press for help they come quickly” and another “Staff are very helpful when they come”. One service user met with was not able to use their call bell and the home had established systems for this service user to ensure their safety and which met their individual needs. All of the home was clean throughout, this included sanitary aids, underneath beds and in bathrooms. One domestic was observed cleaning a service user’s en-suite, she was careful in her duties, cleaning all areas, while continuing to chat to the service user in a friendly way. Of the eleven service users who responded to the questionnaire, eight said that the home was always and three usually clean. One person reported that “The cleaner looks after my room and bathroom absolutely first class. The public rooms always look nice.” The sluice room was clean and well organised. The home’s laundry showed very high standards, all parts, including the areas behind the washing machines and dryers, were very clean and free of dust. The laundry staff are to be congratulated on their high standards. The laundresses showed a good understanding of the principals of prevention of spread of infection and reported that staff in the home complied with policies and procedures when sorting potentially infected laundry. All clinical and other waste was correctly disposed of. Facilities and equipment are provided to ensure that sterile procedures can be correctly carried out. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Amesbury Abbey maintains and exceeds staffing levels to meet resdients’ needs. Residents are protected by the Abbeys’ extensive staff training programmes which ensure that people are in safe hands. Residents are generally protected by the home’s recruitment procedures. EVIDENCE: Amesbury Abbey have Conditions of Registration setting minimum staffing levels, from which they must not regress. They were meeting the condition and at times exceed it, to ensure that they were able to meet the needs of service users. The Abbey is staffed by a core of staff who have been employed for an extended period of time. Other staff come from aboard or are related to army personnel and so may change from time to time. This is not excessive or any more than would be expected for this type of service in this type of geographical area. Staff are prepared to work flexibly to meet the needs of the service, so agency staff are not used. People commented favourably on the support given to them by staff, one said “The staff are marvellous”, another “I’m in good hands here” and another “They do understand”. The Abbey supports staff training at all levels. Nearly all care staff are trained to NVQ 2 or equivalent. All staff are given a comprehensive induction programme on commencement of employment. The training manager covers set areas such as fire safety and general health and safety on the member of Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 25 staff’s first day. The person will then be allocated to a mentor and the training manager will review progress every two weeks or so. Many new employees already hold NVQ qualifications, those who do not, complete their induction over three months. Inductions include reflective practice sections, which were individually completed and marked by the training manager. The home manager signs off each induction with each employee when induction is complete. Ancillary and registered nurses also have an induction, suited to their role. For example, domestic staff inductions included COSSH training, registered nurses medicines administration management. All members of staff have their own training record. These are fully completed and show the wide range of training opportunities offered. Copies of training certificates kept on staff files. The training manager has a matrix for all mandatory training areas, such as fire safety, infection control and first aid training so that she can see at a glance who has completed which training. Attendance at mandatory training is fully supported by the homes’ owner. The training manager reports that staff are keen to attend training and that she does not have to persuade staff or chase them up. The training manager is prepared to work flexibly, for example she has come in, in the middle of the night to train staff on fire safety. The home also offers other training courses in areas relevant to needs of residents in the Abbey. Staff have been trained on many aspects of terminal care, for example, the spiritual and religious aspects of terminal care through to up-dates on syringe drivers for registered nurses. Training sessions are offered most Wednesdays and recent courses have included communication, dysphasia, wound care and diabetes. Training is planned in challenging behaviour and life support for registered nurses. Records of these courses are very clear and detailed. The home’s owner will support staff in going to external training where the training manager can evidence that it will be of benefit to the resident group. The home managers are to be congratulated for their developments and clear records in this area. The files of three recently employed staff were examined. All staff have police checks and two references prior to employment. It was noted as good practice that where one person had put forward a family member as a referee, that this was not accepted and “to whom it may concern” references were also not accepted. Proof of identity and health status statements were obtained for all staff. Where relevant, work permits were held on file. Two of the three persons had full employment histories, one had left that part of their application form blank and while there was knowledge as to why this was, there was no written evidence to show that this had been probed at interview. All care and nursing staff are assessed at interview using an interview assessment tool. Staff are all given terms and conditions of employment, which are signed and dated by the employer and employee. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People are supported by an effective registered manager. There is an established quality audit system. Residents’ financial interests are protected. There was clear evidence to show that staff are fully supervised. There are systems in place to ensure the health and safety of people, however certain areas need more attention as they have the potential to put people at risk. EVIDENCE: Mrs Thomas, the registered manager is an experienced nurse and manager. She regularly updates her clinical skills and holds a Diploma in Stroke Care. She is currently undertaking the Managers’ Award. People were highly complimentary of the manager, one described her as “good, patient, kind and Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 27 gentle” and another reported “I couldn’t manage without her.” Mrs Thomas is supported by a deputy manager, who leads on a range of clinical issues, partially wound care and complex medical conditions. One person described the deputy manager as a “warm, compassionate woman”. The registered manager maintains regular written quality audits of her service, including reviews of accidents, infections, pressure damage and other clinical areas. Where matters are identified which need action, she puts plans in place to ensure that resdients’ needs can be met. The home has a system for sending out questionnaires to people from time to time. Questionnaires had recently been sent out and she was awaiting full return before performing an analysis. The Abbey has standard computerised systems for management of residents’ moneys. No cash is directly handled on behalf of residents. All people have individual monthly accounts completed and residents’ representatives are invoiced. As charges for additional services such as hairdressing, chiropody or sundries come in, relevant persons’ accounts are debited. Full invoices of all charges are maintained. The administrator operates a flexible system, so that persons’ representatives can either pay in arrears or credit their relatives’ account, depending on what is more convenient for them. If people do want cash, for example to go out for lunch, this can be arranged and their account debited accordingly and detailed on their monthly invoice. Records are maintained when valuables are handed in for safekeeping. The home has well established systems for staff supervision. The training manager supervises care staff, the night manager night nursing and care staff and the home manager the day registered nurses. All staff are supported by an annual appraisal from the home manager. The training manager works with care staff on an individual basis, to observe care provision in practice, following this she meets with the person individually to complete the supervision record. Where certain areas have been identified for an individual or the service, she ensures that these areas are included in supervision. For example she has performed several supervisions relating to care of residents during the afternoon period, to ensure that residents’ needs continue to be met at that time. Supervisions were highly individual and positive in tone. Where training needs are identified, the training manager makes sure that they are identified. Annual appraisals are completed in the same tone. Systems are generally in place to ensure health and safety of people. Where residents needed oxygen, appropriate warning notices were placed on their doors and all cylinders were properly secured. All equipment is regularly serviced. The fire log book is maintained as required by the fire safety officers. However some areas do need attention. On the first site visit, a large number of carpets in communal areas were no longer secure and holes were observed in two carpets. This could present a risk of tripping injury to persons with a shuffling gait or a reliance on walking aids. This had been addressed by the Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 28 second site visit. This was discussed with the maintenance manager who agreed to review such matters monthly. It was also discussed that all staff need to be advised of their individual responsibilities for ensuring health and safety and that where staff see risks, such as loose carpets or tiles that need re-grouting in the kitchen, that they are responsible for making a record, to inform the maintenance department. As noted above, the use of bed safety rails are evaluated monthly. In discussion it appeared that monthly safety checks on bed rails were not taking place and this is needed to ensure safety of residents who are assessed as needing such protection. Several service users commented that while the grounds and other areas were “lovely”, they were difficult to access for wheelchair users. One person described them as “not condusive to wheelchair use”. Staff spoken with reported that if service users wished to access the lawns in a wheelchair, they pushed them across the grass. This is not ideal and could lead to a health and safety risk. A risk assessment needs to be performed and a solution identified, so that residents can continue to enjoy the grounds in safety. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 4 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 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 2 17 x 18 3 2 3 3 3 x x x 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 4 x 2 Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 Requirement The home’s statement of purpose and service users’ guide must be up-dated and revised to reflect current service provision. Both documents must agree in relevant areas. The service users’ guide must include a copy of the summary of the inspection report, together with information on how a full copy of the report is to be obtained. Service users’ contracts must be revised to meet regulations about information on fees in homes where nursing is provided, as set out in Regulation 5A Where a service user is assessed as having a risk, a written plan must always be put in place to direct staff on how their risk is to be reduced. The homes policy and procedure on administration of medicines must be revised and up-dated to reflect current practice. The home must ensure that clear records of all complaints, including verbal complaints are DS0000015885.V332452.R01.S.doc Timescale for action 31/08/07 2. OP2 5A 30/06/07 3. OP7 15(1) 31/05/07 4. OP9 13(2) 05/08/07 5. OP16 22(2,3,4) 31/05/07 Amesbury Abbey Nursing Home Version 5.2 Page 31 5. 6. OP19 OP29 13(3) 19(4,b,i), S(2,6) 13(4)(a) 7. OP38 8. OP38 13(4)(b,c) 9. OP38 13(4)(c) made, together with investigations into the matter, outcomes and actions taken. This requirement was identified at the previous inspection with a compliance date of 16/7/06. It has been addressed IN PART. The kitchen floor must be repaired to present an intact, cleanable surface. Full details of a person’s employment record or gaps in employment should always be recorded. Staff must be advised of their individual responsibilities for reporting on issues relating to ensuring the health and safety of all persons in the home. A risk assessment must be completed in relation to persons pushing wheelchairs over grassed areas and if risk is identified, an action plan put in place to address the risk. Responsibilities for performing monthly checks on the safety of bed safety rails must be clarified. 31/10/07 31/05/07 31/05/07 30/06/07 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations As several service users and other persons have commented that the dining room can become cramped and hot when full, the home needs to consider how dining facilities can be improved. The activities co-ordinator and her assistants should be given time to complete personal profiles on all service DS0000015885.V332452.R01.S.doc Version 5.2 Page 32 3. OP12 Amesbury Abbey Nursing Home 3. 4. 5. 6. 7. 8. OP18 OP19 OP19 OP19 OP19 OP19 users. All senior managers and staff who have responsibility for service user finances should be trained in abuse awareness, including the local policy. All stained carpets should be replaced. All scraped corridor areas should be improved and cobwebs removed. Attention should be paid to the walls below the soap dispensers in communal bathrooms, before they deteriorate further. The manager should have ready access to a suitable room to hold meetings with service users, relatives and staff. Consideration should be given to providing a larger staff changing area and a showering facility. Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Amesbury Abbey Nursing Home DS0000015885.V332452.R01.S.doc Version 5.2 Page 34 - 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!