CARE HOMES FOR OLDER PEOPLE
Axbridge Court West Street Axbridge Somerset BS26 2AA Lead Inspector
Shelagh Laver Announced Inspection 12th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Axbridge Court Address West Street Axbridge Somerset BS26 2AA 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) 01179 863997 Almondsbury Care Limited Mrs Beverley Francis Davies Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is to be registered for 36 nursing beds. Date of last inspection Brief Description of the Service: Axbridge Court Nursing Home, formerly the St.Johns Hospital, has been adapted to a two storey home in the centre of Axbridge, close to the local shops. The home is in shared private grounds and has car parking space. There is a large garden area. The home has a large well appointed communal lounge and dining room. The home has mainly single bedrooms with en-suite facilities. The en-suites enable wheelchair access. There is a passenger lift facility to the first floor. Aids and adaptations have been made to promote mobility in the home. There is a nurse call system through out the home. Health and safety measures include covered radiators and window restrictions. The home is registered to provide nursing care for up to 36 people. Personal care can also be provided within these numbers. The manager is a registered nurse and there is a registered nurse on duty at all times. Axbridge Court was purchased by Almondsbury Care on 23 June 2005. The manager, Beverley Davies, was appointed at the same time. She is a registered nurse with considerable management experience. The owners have undertaken a major refurbishment and improvement programme. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection undertaken following the purchase of the home by Almondsbury Care in June 2005. The home had been through a period of difficulty and disruption prior to the purchase. It was very heartening to see the progress made already to restore sound management systems in the home and an improvement in key areas. This announced inspection is based on the core standards specified by CSCI and improvements have been seen despite some difficulties with staffing plans experienced in the home. A tour of the premises took place where all bedrooms and communal areas were seen. Thirteen comment cards had been completed by service users’ relatives and returned to the Commission prior to the inspection. Ten were very satisfied with the care received by the service users. Three felt that at times there were not sufficient staff on duty. All stated that the service users felt safe and were treated well. One highlighted a particular care issue that was discussed and resolved during the inspection. Twenty-one service users and eight staff were spoken with. The registered manager was available through out the day to assist the inspectors. Records relating to care, staff and health and safety were examined. What the service does well:
Service users spoken to during the inspection stated that staff are kind and that their health needs are met at Axbridge Court. The home is in a quiet attractive small town environment. After a very short period of time in the ownership of Almondsbury Care there is evidence of the high standard of decoration that is aspired to. The manager of the home is experienced and capable and is supported by the home owners in the common goal of delivering a high standard of care to service users. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The staff should continue to develop and improve the recently introduced Standex care planning system. Further training should be provided for all staff emphasising not just the importance of recording information but also underlying principles of the necessity to plan and review care individually for service users. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 7 Staff supervision continues to be informal mainly as a result of a shortage of permanent trained nurses. Issues do arise relating to care practice which should be addressed in regular formal supervision sessions with staff. 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. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 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 Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 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. All service users have contracts that detail the terms of their stay in the home. The assessment process is documented to show how the decision that home could meet the service users needs was made. Care staff are receiving training in dementia care. EVIDENCE: The contracts of three service users were observed and seen to be clear and signed by service users or their relatives. The manager is currently assessing all service users prior to admission. Occasionally emergency admissions are taken at the request of GPs. The inspectors observed pre admission records now completed for prospective service users. Staff completing the initial care plan in the home should refer to pre-admission information collected to verify and complete the care planning documents.
Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 10 The home has several service users who have degrees of dementia. The service users also have physical nursing needs that can be met in a nursing home. Staff have received some training in the care of these service users and further training is planned. The training has been provided by a skilled practitioner. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 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. All service users have individual care plans in which their care needs are set out. The detail and skill of recording varies. Medication is administered safely. Service users privacy and dignity is respected. EVIDENCE: The implementation of the Standex care planning system in the home has been completed. There has been improvement since the last inspection and some plans demonstrated good practice. There is a need to standardise care plans so that all show service user involvement when applicable. All records must be signed and dated. Base line assessments on admission including weights must be recorded. There were examples of health needs identified in pre-admission assessments that were not included in the care plan for example poor appetite, the need for care with bowel management and information relating to pressure areas. The nurse
Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 12 completing the care plan initially should refer to all pre-admission documents to ensure the maximum effectiveness is gained from the care planning process There was evidence that service users physical health needs were met and that a range of health professionals were contacted when required. The records of administration of medication met the National Minimum Standards and an audit system has been implemented to ensure continued attention to detailed records. Service users felt they are treated with respect and their right to privacy is upheld. The perceptions of staff regarding the protection of service users dignity should be regularly reviewed and re-inforced as part of an on-going practice review as discussed during the inspection. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 13 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. The home provides sufficient tasty food and serves this in an attractive well equipped dining room. Family and friends are welcomed into the home. The home is making changes that are designed to improve the social and recreational experiences of service users. EVIDENCE: Service users spoken to enjoyed the food that is provided. The menu displayed showed choice and variety. On the day of inspection there was a choice of lunch. The food served was appetising and sufficient in quantity. The presentation of special menus was attractive. A file recording service users interests has been established. It should include information of activities enjoyed prior to admission. A programme of activities is established using this information. All records in the file should be signed and dated. The activities co-ordinator must have a training plan that is drawn up following an initial appraisal to ensure her continued development in the role.
Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 14 There was evidence that service users were able to spend their days in a variety of ways according to their preference and state of health. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 15 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, 17 & 18. Appropriate measures are taken to protect service users from abuse. EVIDENCE: CRB checks and references are requested for staff but must be received prior to commencement of employment even when staff are supervised. . There is a complaints procedure in place. Service users spoken to knew who the manager was and were able to raise concerns with staff. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 16 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. There has been up grading of facilities and furnishings since the last inspection. The home was clean and comfortable. Specialist equipment is available for service users. EVIDENCE: The inspectors observed that substantial work is being undertaken to improve the environment of the home. At this inspection the corridors and hallways were being decorated. Considerable investment is being made in the infrastructure of the home as well as cosmetic improvements. Service users bedrooms were comfortable and at this inspection it was evident that the home was much tidier. Cupboards have been provided in the ensuites for personal requirements.
Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 17 The home employs a team of domestic staff and on the day of the inspection the cleanliness of the home was good. Many service users had specialist pressure relief or manual handling equipment. The type of equipment required should be recorded in the care plan. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 18 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. Rotas indicate there are sufficient and appropriate staff on duty. Appropriate recruitment procedures are followed by the manager at the home. Staff have received sufficient mandatory training to do their jobs. EVIDENCE: There was evidence that additional staff have been continually recruited to augment the established core of staff. The appointment of a full time deputy manager will greatly assist the manager and efforts are still being made to make this permanent appointment. The duty rotas show that there are always trained staff and sufficient numbers of care staff on duty. There have been staffing issues as staff leave suddenly or experience sickness. There are many part-time staff in the home which can make continuity of care an issue. The manager is continues to manage the staff situation as effectively as possible. Staff have received manual handling, fire training and food hygiene training. Two sessions of dementia care training have been provided. Staff spoke positively about the NVQ training programme that is being implemented. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 19 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, 32, 33, 34, 35, 37 & 38. The home is increasingly effectively managed by the registered manager who promotes a clear and inclusive style of management. The home’s systems for ensuring the health, safety and welfare of service users and staff have improved since the last inspection. EVIDENCE: The chief executive makes regular visits to the home and completes detailed Regulation 26 reports. The manager is enthusiastic and competent and has already made progress in improving the running of the home. The amount of work required in the home at the time of purchase has resulted in a significant challenge and the appointment of a deputy manager will greatly assist her.
Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 20 At the time of this inspection, the home was taking appropriate steps to ensure the health & safety of service users, staff and visitors to the home. The following records were examined: FIRE – Records indicated that appropriate checks were being carried out on the home’s fire detection and fire fighting equipment. Regular training is conducted for all staff. Emergency lighting is tested monthly. SERVICING – A full range of servicing had been undertaken. Certificates were seen for the home’s electric hard wiring and gas supply. Hoists were serviced by an outside contractor in accordance with LOLER regulations. The inspectors discussed with the maintenance manager the need to ensure hoists were inspected six monthly. Bedrails are in use for those service users with an assessed need. There is now a system of assessing and maintaining all rails to ensure they comply with the MDA guidance. PORTABLE APPLIANCES – This will be checked at the next inspection. Evidence of checking was observed on appliances in the home. ACCIDENTS – The home maintains records relating to accidents at the home. Records must show that action has been taken to prevent further incidents when possible. Risk assessments must be complete when it is agreed that service users will benefit from a wheel chair strap. The manager must begin an analysis of accident records to identify any traits. HOT WATER/SURFACES – All radiators are of a low surface temperature type which reduce the risk of injury to service users. Bath hot water outlets are thermostatically controlled to reduce the risk of scalding. Monthly checks are made to ensure that the temperature does not exceed the HSE recommended limit of 44C. Those checked at this inspection were found to be within the acceptable limits. Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x 3 x x 2 3 Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Further training and monitoring must be provided to ensure that all care plans are fully completed and signed. They must reflect the full range of service users needs and must give clear direction to staff of the action to be taken to meet these needs. Risk assessments must be completed whenever it is necessary for a service user to use any restraint equipment (wheelchair lap strap). Staff recruitment must at all times comply with NMS including two written references. (Schedule 3 Care Homes Regulations). Timescale for action 01/05/06 2. OP38 13 4(b) 01/01/06 3. OP29 19 01/02/06 Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 23 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 OP12 Good Practice Recommendations A programme of social activities based on the requirements of service users should continue to develop. Training should be provided for the newly appointed co-ordinator. Accidents records should be audited on a regular basis. All records relating to service users should be signed and dated. 2 2. OP38 OP37 Axbridge Court DS0000064451.V268728.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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