Inspection on 18/05/06 for Amesbury Abbey Nursing Home

This inspection was carried out on 18th May 2006.

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

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

Other inspections for this house

Amesbury Abbey Nursing Home 10/02/09

Amesbury Abbey Nursing Home 13/04/07

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 Key Inspection 18th May 2006 9:50 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.V293530.R01.S.doc Version 5.1 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.V293530.R01.S.doc Version 5.1 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.V293530.R01.S.doc Version 5.1 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 11th October 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 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. 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. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place on 18th May 2006 between 9:50am and 5:15pm, in the presence of the deputy manager. During the site visit, the Inspector met with 23 service users and observed care for nine other service users who were unable to converse. The Inspector reviewed records relating to nine service users in detail. The Inspector also met with five care assistants, two registered nurses, the hotel services manager, the chef, both laundresses, two waitresses and the receptionist. The Inspector observed one mealtime and performed a tour of the building, including the laundry and kitchen areas. All systems for storage and recording of medicines were inspected, together with systems for storage of sterile supplies. A second site visit was performed on 16th June 2006, between 9:20am and 2:05 pm to review areas which could not be covered on the unannounced site visit. This included meeting with the training manager, discussions with two assistant activities coordinators, the administrator and the maintenance man. Records reviewed included five staff employment files, records of training and supervision, maintenance records and complaints records. A brief tour of the building was made to review progress towards addressing areas identified at the site visit. As part of the inspection, questionnaires were sent out to service users and were completed and returned by eleven service users. Several relatives and two of the GPs who work with the home also commented on the services provided. 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. 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 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 home has effective working relationships with local healthcare services and call in healthcare professionals with extended skills when needed. There was evidence that the registered nurses are aware of current researchbased evidence in meeting healthcare needs, particularly in relation to continence care, wound care and diabetic care. Visitors are actively Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 6 encouraged and the home has a range of systems in place to support family, friends and members of the local community in coming into the home. Service users expressed their appreciation of the home, one said “Its marvellous here”, another “I couldn’t find anywhere better”, another “I’m very happy here” and another described the Abbey as “far and away the best”. Service users also said how supportive the staff were, one said “The girls are very nice and good” , another said “They’re very helpful” another said “I love talking to them” and one described the staff as “darlings”. One described a particular member of staff as “My very best person”, one service user described the night staff as “so kind” and another said that the night staff were “able to give you time”. What has improved since the last inspection? What they could do better: At this inspection, ten requirements and seven recommendations were identified. All service users/representatives must be given their own copy of the service users’ guide, to fully inform them of the services offered. The home must ensure that it only cares for service users as specified in their Conditions of Registration to ensure that they are in a position to meet the needs of all the people they care for. Where evaluations or other information show that service users’ care needs have changed, their care plan must always be promptly updated, so that staff can be fully informed of how to meet their needs. The home must ensure that clear records of all complaints, including verbal complaints are made, together with investigations into the issues, outcomes and actions taken so that they can demonstrate that they are taking all Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 7 complaints seriously. All staff who have contact with service users, including domestic, catering and maintenance staff must be trained in abuse awareness, to ensure service user safety. The home must ensure that where a vulnerable adult is at risk, that they are referred promptly to appropriate authorities in accordance with local vulnerable adults procedures, to ensure their safety. The bathroom on the ground floor must be provided with additional/sufficient heating. The damaged areas in the wall around the clinical hand wash basin at the nurses’ station must be repaired to provide a wipeable surface, to ensure that the area can be properly cleaned to prevent micro-organism growth. The registered manager must commence Registered Managers training, to support her in the managerial part of her role. The home must always inform the Commission of any event which could seriously affect the well-being of service users, so that they are made aware of actions taken to protect service users. The home must ensure that there are safe systems for exiting one area of the home, which conforms to fire safety policy, for the protection of service users, staff and visitors. Where service users are prescribed drugs which can affect their activities of daily living, this should be included in their care plans, to further develop and improve monitoring systems. The home should extend and further develop activities, particularly for frail service users or those with dual care needs. An interview assessment tool should be used when assessing prospective employee’s suitability for their role. Descriptions of items handed in for safekeeping should not use wording such as “gold” or “silver”. The induction programme for registered nurses and ancillary staff should be further developed. All clinical supervisions for registered nurses should be made in writing. Waitress staff should be trained in manual handling. 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.V293530.R01.S.doc Version 5.1 Page 8 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.V293530.R01.S.doc Version 5.1 Page 9 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, 2, 3, 4 & 5. The home does not provide intermediate care, so 6 is N/A Service users are admitted to the Abbey after a full assessment of their nursing and care needs. Pre-admission visits are actively encouraged. All service users are issued with a contract. The home cannot evidence that they make the service users’ guide available to all, to inform about the service provided. The home are caring for some service users whose prime needs have changed and are now outside their categories of registration. Therefore they cannot meet these persons’ needs. Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: All eleven service users who responded to the questionnaire reported that they had been provided with all the information that they needed to make a decision to come into the home. Potential service users have a full assessment of their nursing and care needs prior to admission, by the manager or her deputy. Two recently admitted service users said that they had actively chosen to come into the Abbey and that they found it met their needs. Staff spoken with had a clear understanding of meeting these service users’ needs. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 10 Before admission, service users and their families are invited to come to the Abbey and spend some time there, looking at their prospective apartment, having a meal and meeting with other service users. One service user said that they had known the home for a period of time, so it had been an obvious choice for them, another said that they had been too unwell to visit the home in person before admission but that their family had done so. Ten of the service users who responded to this section of the questionnaire said that they had been given a contract. One service user who had been in the home for a longer period of time reported that they had not kept a copy of their contract and that they had asked the home for another copy. They said that the contract was very detailed and “covered every area”. A copy of the home’s statement of purpose and service user’s guide is available in the entrance hall, both conform to requirements. However a copy is not routinely made available to service users and their supporters and this is required. It was agreed that a copy of the home’s service users’ guide will be made available in each service users’ apartment. Amesbury Abbey is registered to care for older persons, persons with a physical disability and terminal illness only. It is not registered to care for persons with prime needs for dementia care. During the inspection, it was identified that the home was caring for at least two persons whose prime care needs were now for dementia care and who were exhibiting behaviours which the home could not meet. The site manager was advised that either the home must apply to be registered to care for persons with such care needs and provide a safe environment for persons with such care needs and staff with appropriate training or they must ensure that they only care for persons for whom they are registered. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 11 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 Service users are supported by care plans, which detail their individual nursing and care needs. Where service users’ conditions have changed care plans must be promptly up-dated, to reflect their changed needs. Care plans are working documents, used by staff and reflect what service users said. The home can demonstrate that frail service users healthcare needs are met. Service users are respected and treated with dignity. Safe systems are in place for the administration of medicines. Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Amesbury Abbey have gradually developed their approach to care planning over the past few years. Care plans relating to personal care are very clear and direct actions to be taken to meet nursing and care needs. For example if a service user is assessed as needing a range of topical applications, there are clear written details of what applications are to be used and when. Some service users have dual mental health care needs, most of these service users have clear assessments and care plans in place, which direct staff on actions to take, they are written in non-judgemental language. However two service Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 12 users were identified during the inspection whose mental health needs had recently changed and their care plans must be up-dated to reflect their current needs and to direct staff on their current needs. Where service users are assessed as being at risk of pressure damage or dietary risk, there are care plans in place. Some very are detailed. For example one service user had particular needs in relation to positioning when in bed, this was fully documented and observed to be actioned by staff when caring for the service user. Care plans are evaluated monthly. Service users’ records indicated that they or a member of their family were consulted with about their care plans. One service user told the Inspector of a particular need, which they had not been aware of, which staff had discussed with them and how they had agreed with staff how this care need was to be met. Staff spoken with were fully aware of how to meet service users’ care needs, reporting that they were able to discuss service users’ changing needs during report and that they accessed the care plans, finding them useful in directing them in how to meet service users’ needs. Amesbury Abbey cares for some very frail service users. Care for such service users is monitored by frequent care charts. These were completed in full for all such service users, demonstrating that they were turned frequently and offered fluids on a regular basis. The home have recently been working with external trainers and the local hospice, to develop end of life care plans, these will be progressively introduced, following staff training. Staff clearly knew individual residents well. All personal care was provided behind closed doors. Care staff called service users by their own preferred names. The laundresses have systems in place to ensure that service users’ own clothing is returned to them. One service user said “we’ve a wonderful laundry system”. Where service users need assistance, this was performed in an unrushed and supportive manner. For example, one service user felt unable to continue walking with a frame, the carer with them promptly got a wheelchair and supported them, not rushing them, advising them on what to do in a calm and kindly manner. One service user described to the Inspector how they had developed their own system for ensuring their privacy when they wanted it and that staff respected this and also advised visitors as appropriate. There was evidence of effective working links with local GPs. One service user had shown complex changing needs on the day before the site visit, they had been promptly referred to their GP for tests. Of the eleven service users who responded to questionnaires ten said that they always or usually received appropriate medical support. Two GPs commented on the quality of care provided by the nurses and care staff. Staff ensure service users receive healthcare support, such as chiropody or physiotherapy when needed. An optician was visiting the home at the time of the inspection, visiting service users in their own rooms. The home have close working relationships with the continence nurses, community psychiatric nurses and Macmillan nurses. It is Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 13 much to the home’s credit that they actively support interventions to prevent and manage incontinence and only one service user had a urinary catheter in place. Records as to why this was indicated for this service user were clear. Only one service user had a wound, this wound is responding well to treatments and does not need sterile procedure. Amesbury Abbey as safe systems for the storage of drugs. A full audit trail of drugs brought into the home and disposed of is in place. Some service users are fully or partially self-medicating, risk assessments are in place for such service users, these are regularly evaluated. Where service users are partially self-medicating, the home has a policy and procedure for documenting this. Where service users need administration of medicines by invasive procedure, full records are in place. Some service users are prescribed drugs which may affect their activities of daily living, such as mood-altering drugs, aperients or pain killers. Where such drugs are prescribed, it is advisable to crossreference this to care plans, so that staff providing care are in a position to advise registered nurses and medical staff as to the on-going effectiveness of such interventions. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Amesbury Abbey is developing a system in place to ensure that service users’ social and recreational needs can be met. Families and friends are encouraged to visit and retain close links with the service user. Service users reported that they could choose how they spent their days. A varied diet is provided in supportive surroundings. The menu is regularly reviewed, to try to meet the preferences of the different service users in the home. Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Amesbury Abbey has, over the past two years, gradually begun to introduce activities for service users with more complex needs. Service users’ social care needs are documented and regularly evaluated. Amesbury Abbey employs a part-time activities-coordinator, who is supported by two carers with interest in the area. This activities coordinator is booked to attend a relevant training course, to extend her skills. Service users reported on group activities provided, such as the exercise classes. The two carers who support the activities coordinator reported on small group activities provided at the weekends. Both carers were enthusiastic and keen to develop their role. Of the eleven service users who responded to questionnaires, nine said activities to meet their needs were usually or sometimes provided. The home needs to Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 15 develop their approach to activities further, so that frail persons, who are not able to source their own activities or have a dual health care need can be provided with effective recreational support. Some service users were being taken out of the home on a trip to look at bluebell woods on the afternoon of the site visit. Some of the service users are able to go out independently, other service users said that they appreciated staff taking them out to look at the grounds in fine weather. Many of the service users said how they had enjoyed the recent church fete, which had taken place in the grounds of the home. Visitors are encouraged to visit and service users reported that they appreciated how visitors could come to the home at any time. Many service users go out regularly with members of their family or friends. One service user is visited every day by their dog. Where service users have friends or family living in the mews flats, they are supported in maintaining contact, in the way that they prefer. Staff reported on close working links with families and friends of service users and how important such relationships were in meeting service users’ needs. Relatives commented on how supportive staff were to them and how they maintained contacts with relatives to ensure that they were fully informed of relevant matters. One commented on how senior nursing staff always took time to talk to them about their relative’s condition whenever this was needed. Service users reported that it was up to them as to how they spent their time, they could get up in the morning and go to bed when they wanted, they could also decide whether to go to the dining room for meals or not. One service user said “I can be myself here”, another “It’s completely up to me how I spend my days here” and another “One is absolutely free to do what one wants here”. As would be anticipated in a large establishment, there was a wide range of opinion expressed by service users on the meals provided. The menu has recently been further revised to address a range of comments from service users and staff. One service user said that meals were now “much better”. Of the nine service users who responded to the questionnaires, eight said they usually or sometimes liked the meals. Comments from service users varied from one service user who described meals as “the problem”, another as “going down in standard”, through one who said meals were “not too bad”, another who described meals as “fairly various” to one who described meals as “perfectly alright”, another as “jolly good” and four who said that meals were “very good”. Service users may eat their meals in the dining room, served by waitresses or in their own rooms on a tray. Service users may invite relatives and friends to lunch and may eat with them in their own room or the drawing room if they wish. Where service users need assistance to eat their meals, staff sit with them, encouraging and supporting them. Equipment to support service users, such as plates with integral plate guards are provided. The chef showed a good Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 16 knowledge of special diets, such as reducing and diabetic diets, and there was evidence that he works closely with nursing staff, to ensure that what has been ordered by service users will meet their dietary needs. A wide range of different drinks are available to service users, including fresh orange juice and cranberry juice. Where a service user has a wound, additional protein supplements are provided. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 17 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 The home does have a complaints procedure, but full records of complaints made are not maintained when issues are raised and there is no evidence of actions taken to address complaints. This means that the home cannot demonstrate that complaints are taken seriously. Some staff are trained in abuse awareness, however some other key staff have not been trained in the area. On at least four occasions, reporting has not taken place in matters relating to vulnerable adults procedures, therefore the home is not able to show that it is giving full consideration to the protection of vulnerable persons. Quality on this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Amesbury Abbey has a complaints procedure, which is in the home’s service users’ guide, however as noted in Standard 1 above, the guide is not made available to all service users. Service users spoken with reported that they knew how to bring up issues of concern. Of the eleven people who responded to questionnaires, six said that they always knew who to speak to and five that they usually did. One service user said that they always talked to the manager or deputy if they had any concerns and another described how the manager or deputy always sat and listened to them. One service user said that they brought up issues with the site manager, hotel services manager or receptionist. One service user said that the manager would “definitely” sort out any concern they had and another said that they had talked to the manager in the past and that she had “sorted it all out”. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 18 One service user brought up an issue with the Inspector, which they regarded as a complaint, which the site manager was aware of. Evidence from the questionnaires and discussions with service users during the first site visit indicate that they felt that they had raised issues of concern to them. However no record of matters had been made in the home. The nursing and care staff maintain an informal record of concerns and other issues raised by or demonstrated by service users and their relatives. This record is helpful in documenting issues that have been raised, however a more systematic approach is needed in documentation of complaints, so that outcomes and actions taken are documented. The training manager is to attend an accredited abuse awareness course in the Autumn, she will then cascade the training to all staff in the home. Nursing and care staff report that they have been trained in abuse awareness. All newly employed staff are given a copy of the “No Secrets” booklet. Care staff said that they felt able to report any concerns to the sisters and that they would be listened to. One service user’s record documented a matter which should have been reported immediately by a member of the ancillary staff rather than more than two days after the occurrence was first observed. Discussions with the hotel services staff indicated that they are not trained in abuse awareness. As ancillary staff have service user contact, they need to be made aware of the importance of protecting vulnerable adults. During a review of records, it was identified that four different issues had occurred into relation to the protection of at least two different vulnerable persons. This had not been reported in accordance with local vulnerable adults procedures. This is of concern, as these procedures have been in place for a period of time. These procedures they have been put in place to ensure the protection of vulnerable persons. The home does have past experience of working within vulnerable adults procedures and therefore should have been aware of how to instigate the procedure. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 19 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, 25 & 26 Amesbury Abbey presents a comfortable and clean environment for service users. Generally most of the home is well maintained and many improvements have been made to facilities and equipment provision during the past few years. One area of maintenance had not been attended to between the two site visits. One area also needs additional heating. Quality on this outcome area is generally good. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Amesbury Abbey is a large building, which due to its age and size needs regular maintenance. At the time of the site visit, due to a leak, a large area of ceiling and wall had been damaged in one corridor on the first floor, with the rafters and under-surfaces showing through. On the day of the second site visit action was being taken to address the matter. Many of the corridor carpets have been replaced since the last inspection. On the first site visit two of the joints between carpets were not secure and had been covered by taping, which was lifting off, this could present a risk of tripping injury to frail service users. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 20 Similar matters have been identified at previous inspections. By the second site visit, this had been addressed. 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. One service user said “I’m so lucky to have this room.” Service users furnish their own rooms, this means that they are all highly individual in style. 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. Since the previous inspection, the drawing room has been fully redecorated and provided with new furniture in keeping with its atmosphere. A call bell has been provided in the dining room to ensure staff can be alerted promptly by waitresses when needed. The Abbey has extensive grounds and nearly all room windows have very attractive views. The main drive has been fully re-laid and all pot-holes removed. One service user said “I adore the grounds here” and another described them as “simply lovely”. The Abbey has much improved its bathing facilities over the past few years and full disabled facilities are now available on every floor of the home. The Parker bathroom felt cold on the site visit. One service user reported that they found the room cold, as did one member of staff. The room is heated by a small wall-mounted fan heater, which is at a distance from the bath. When it was turned on by the Inspector, it did not heat all the area of the bathroom. The hairdressing saloon has been fully re-decorated since the previous inspection, it presents an attractive, professional appearance and additional heating has also been provided. Service users reported that this made the room a much more pleasant area. A range of equipment is provided to meet clients’ needs. A step leading up to the second floor bathroom has been ramped, to provide easier access for wheelchair users and frail persons. 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, including profiling beds. Service users commented in the questionnaire and verbally to the Inspector on how long it took for call bells to be answered. The home has an electronic monitoring system for call bells. This record was reviewed during the inspection and it was identified that most bells were answered within four minutes. On the few occasions when they were not, response times were always within six minutes and related to times when more than three persons were using their call bells at the same time. All of the home was clean throughout, this included sanitary aids, underneath beds and in bathrooms. Of the eleven service users who responded to the questionnaire, six said that the home was always clean and five usually clean. One service user described their cleaner as “excellent”. There is a new washer disinfector in the sluice room on the ground floor. This sluice room was clean and well organised. The home’s laundry was clean and tidy. The laundresses Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 21 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. The wall behind and shelf above the clinical hand wash basin in the nurses’ station shows deteriorating surfaces and could not be properly wiped down. To prevent risk of micro-organism growth, they need to be repaired, to provide a fully wipeable surface. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 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. Service users are protected by a safe recruitment system for new staff. Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. 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. Staff are prepared to work flexibly to meet the needs of the service. Staff spoken with were enthusiastic about their roles and were observed to work effectively together. Staff said how helpful they found the induction and further training and that they were supported in their roles. Generally service users felt that staff were able to meet their needs. The home employs a training manager who has put much work into developing staff training programmes. Records are well maintained and reflect the range of areas supported by the home. The home is supportive of NVQ training and a high proportion of staff are trained to NVQ 2 or above. Staff also receive Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 23 training in a range of other areas, for example staff in the home have been taking part in the End of Life Project and four of the senior staff, including the manager, were attending training at the local hospice on the day of the site visit. The home has a safe system for staff selection and recruitment. All staff submit an application form, proofs of identity are sought. CRB and pova checks are undertaken on all staff. All staff submit a health status questionnaire. Two references are sought for all staff. “Two whom it may concern” references are not accepted. Where the person’s current employer is not prepared to submit a reference, additional references from other relevant persons have been obtained. All staff are interviewed prior to appointment. Discussions about how to introduce interview assessment tools took place and the manager is planning to introduce one. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 The home is managed by an experienced nurse and manager, who up-dates her clinical skills regularly. She needs to complete a manager’s award to update her managerial skills. The manager performs quality audits. Service users financial interests are protected. Staff are regularly supervised. The home needs to ensure that it always informed the Commission of matters which could seriously affect service users well-being. Most matters relating to health and safety are in place, apart from one area relating to fire safety. Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: The home manager is an experienced nurse and manager. She regularly updates her clinical skills and has recently completed an external Masters Degree relating to clinical care. The Commission was aware that she was Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 25 undertaking this qualification, however now that it is complete, she needs to commence developing her managerial qualifications and needs to commence working towards the Managers Award. This is to ensure that she has the correct skills to perform her managerial role. The 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 service users’ needs can be met. The home has a system for sending out questionnaires to service users from time to time. The home does not look after service users’ moneys. Most fees are paid by their appointees and invoices are settled on a monthly basis. Where service users do pay their own fees, they are invoiced and full records maintained. Notifications of increases in fees are put in writing one month prior to their taking effect. The home charges separately for services such as chiropody, hairdressing and purchases from their shop. These are documented and the service user or their representative is invoiced monthly. The home keeps a small safe for storage of items. A new record was introduced during the inspection, in a bound book. The home are advised that the apparent value of an item such as “gold” or “silver” should not be used and words such as “yellow” or “white “ be used. While the home are largely maintaining all records as required, however as documented in relation to Standard 16, there are deficiencies in documentation of complaints and protection of vulnerable adults. The home have not notified the Commission of at least four incidents, one of which took place as far ago as April, which could have seriously affected the well-being of service users, as they are required to do. This is of concern as this is part of regulation and such matters needs to be sent in to the Commission on when they happen and not be identified later on during the course of a Key inspection. All newly employed care staff are allocated to a mentor, who supports them during their induction period. At the end of their induction period, they receive formal supervision and any future training needs are identified. Registered nurses and ancillary staff also receive an induction. The manager and training manager are planning to work on this, to develop an induction programme which is suited to the service itself and different member of staffs needs. This will be documented in the same manner as for care staff. All care staff are regularly supervised, this involves the supervisor working with the supervisee and a record is maintained. The manager performs an annual appraisal on all staff. Clinical supervision has been introduced for registered nurses on night duty and while there was verbal evidence that this was taking place for day registered nurses, this was not in writing. The training manager ensures that all staff are regularly trained in all matters relating to health and safety and clear records are maintained. It was Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 26 observed during the inspection that waitress staff in the dining room may support service users in a range of areas. They should receive manual handling training, to ensure that they are fully aware of how to correctly support service users. All staff are trained in fire safety. The maintenance manager performs monthly fire drills at different times of the day and from different points in the building, to ensure that all staff are aware. All equipment and systems in the building are regularly maintained and the fire log book is correctly up-dated. It was observed during the inspection that one service user was being protected by the use of certain equipment, which could be blocking a fire exit. Alternative solutions were discussed and need to be introduced promptly to ensure safety of all persons in the area. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 1 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 3 3 4 3 2 2 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 2 X 3 X 3 3 1 2 Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP4 Regulation 5(1)(2) 12(1)(a) (b) Requirement All service users/representatives must be given their own copy of the service users’ guide. The home must ensure that it only cares for service users as specified in their Conditions of Registration OR that it applies to register to care the persons being cared for, who are outside their categories of care. To do this they must be able to demonstrate that the home environment and staff training is suitable for such service users. Where evaluations or other information show that service users’ care needs have changed, their care plan must always be promptly up-dated. The home must ensure that clear records of all complaints, including verbal complaints are made, together with investigations into the matter, outcomes and actions taken. All staff who have contact with service users, including domestic, catering and maintenance staff must be DS0000015885.V293530.R01.S.doc Timescale for action 31/08/06 16/07/06 3. OP7 15(1)(c) 16/07/06 4. OP16 22(3)(4) 16/07/06 5. OP18 13(6) 31/12/06 Amesbury Abbey Nursing Home Version 5.1 Page 29 6. OP18 13(6) 7. 8. OP25 OP26 23(2)(p) 13(3) 9. 10. OP31 OP37 9(2)(b)(i) 37(1)(e) 11. OP38 23(4)(b) trained in abuse awareness. The home must ensure that where a vulnerable adult is at risk, that they are referred promptly to appropriate authorities in accordance with local vulnerable adults procedures. The bathroom on the ground floor must be provided with additional/sufficient heating. The damaged areas in the wall around the clinical hand wash basin at the nurses’ station must be repaired to provide a wipeable surface. The registered manager must have commenced Registered Managers training. The home must always inform the Commission of any event which could seriously affect the well-being of service users. The home must ensure that there are safe systems for exiting one area of the home, which conforms to fire safety policy. 23/06/06 31/08/06 31/07/06 28/02/07 23/06/06 23/06/06 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 OP9 Good Practice Recommendations Where service users are prescribed drugs which can affect their activities of daily living, this should be included in their care plans, to further develop and improve monitoring systems. The home should extend and further develop activities, particularly for frail service users or those with dual care needs. DS0000015885.V293530.R01.S.doc Version 5.1 Page 30 2. OP12 Amesbury Abbey Nursing Home 3. OP29 4. 5. 6. 7. OP35 OP36 OP36 OP38 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 has not yet been introduced). Descriptions of items handed in for safekeeping should not use wording such as “gold” or “silver”. The induction programme for registered nurses and ancillary staff should be further developed. All clinical supervisions for registered nurses should be made in writing Waitress staff should be trained in manual handling. Amesbury Abbey Nursing Home DS0000015885.V293530.R01.S.doc Version 5.1 Page 31 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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