CARE HOMES FOR OLDER PEOPLE
Axbridge Court Nursing and Residential Home West Street Axbridge Somerset BS26 2AA Lead Inspector
Shelagh Laver Announced 8 September 2005 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 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 Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Axbridge Court Nursing and Residential Home Address West Street Axbridge Somerset BS26 2AA 01934 733379 01934 733379 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Almondsbury Care Limited Mrs Beverley Davies Care Home with Nursing 36 Category(ies) of Old age not falling within any other category registration, with number (OP) of places Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is to be registered for 36 nursing beds. Date of last inspection 8 March 2005 Brief Description of the Service: Axbridge Court Nursing Home, formerly the St.John’s 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. There is a registered nurse on duty at all times.
Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection undertaken following the purchase of the home by Almondsbury Care in June 2005. The home has been through a period of difficulty and disruption prior to the purchase. It will take some time for the new proprietors and manager to implement changes that will enable all standards to be fully met. It was very heartening to see the progress made already to restore sound management systems in the home. This announced inspection is based on the core standards specified by CSCI. A further announced inspection will take place in December 2005 when it is to be hoped that further substantial improvements will be seen. This announced inspection took place over 1 day (5.5hrs) and was conducted by two inspectors. A tour of the premises took place where all bedrooms and communal areas were seen. Twelve service users’ comments cards had been returned to the Commission prior to the inspection. Several had been completed on behalf of service users by relatives. All stated that the service users felt safe and were treated well. Fifteen service users and eight staff were spoken with. The registered manager was available in the morning to assist the inspectors. She had been on duty the previous night to cover sickness. Records relating to care, staff and health and safety were examined. What the service does well:
The majority of service users 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, capable and is supported by the home owners in the common goal of delivering a high standard of care to service users.
Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The manager has been in post for three months and has undertaken a substantial review of systems and policies. Inevitably time has been taken up in day-to-day management and “trouble shooting”. In the next three months with the appointment of a full time deputy manager it is to be expected that she will have the opportunity to address many of the following issues. Records of pre-admission assessments must be improved and formalised. Care plans must be improved. There are plans to implement a new system of care planning documentation. The provision of social activities in the home is currently poor. The social needs of able and articulate service users are not met. There is currently no formal system of planning or reviewing the ways in which the social and psychological needs of frail service users are met. There are advanced plans to make an appointment of activities co-ordinator. The staff need training in caring for service users with some degree of dementia. The home is primarily meeting the physical needs of service users however in order to deliver holistic care other needs must also be recognised and met when possible.
Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 7 An immediate requirement was made with regard to medication and an audit was required of all bedrails in the home to ensure the fittings complied with MDA guidance. 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 Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 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 standard(s) 2, 3 and 4. All service users have contracts that detail the terms of their stay in the home. The assessment process must be fully documented to show how the decision that the home could meet the service users’ needs was made. Care staff must be trained in dementia care. EVIDENCE: The contracts of four 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. Currently there are no pre admission records other than those included in the care plan system. A clear record of the pre-admission assessment must be kept showing when a visit was made to meet the service user or if no visit was made how the decision that the home could meet the service users’ needs was made. The appointment of a full-time deputy manager will make it possible to share the assessment process.
Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 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. However staff must receive training in the care of these service users. The training must include how service users who have disturbed behaviour can be managed to reduce their anxiety and confusion. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. The documentation of care planned is incomplete and does not give sufficient clear direction of the care needed. There was evidence that service users’ physical health needs were met. Attention to detailed recording is necessary in the administration of medication Service users felt they are treated with respect and their right to privacy is upheld. EVIDENCE: The care plans of four service users were observed. Care plans showed that there was contact with a range of health care professionals. Care plans observed were poorly completed. Basic information such as observations and weight on admission were not recorded. The system of medication storage and administration is basically sound however an immediate requirement letter was issued as a result of poor recording practice. Variable doses must be recorded to show the amount of
Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 12 medication taken by the service user. Prescriptions written on the MAR sheets by nurses must have two signatures. Trained nursing staff must be aware that this practice protects the service users and themselves in ensuring that prescriptions are accurately recorded. It is recommended that medication audits are undertaken by the home manager to emphasise the importance of addressing this quite straightforward good practice in medication management. Staff were observed speaking to service users appropriately and doors were closed whenever care was delivered. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 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 standard(s) 15. The home provides sufficient tasty food and serves this in an attractive wellequipped dining room. EVIDENCE: Service users stated in feedback cards and in person to the inspectors that they enjoyed the food that is provided. 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. Service users were observed being wheeled into the dining room up to forty minutes prior to the serving of the meal. Service users must be supplied with a drink during this time. The manager must discuss the menu with the chef to ensure healthy eating choices at all meals. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18. Appropriate measures are taken to protect service users from abuse. EVIDENCE: CRB checks and references are requested for staff. 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 Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25, 26. There has been up grading of facilities and furnishings since the last inspection. Many areas still require redecoration and some of the furniture would benefit from replacement. There are plans in place to ensure this happens. EVIDENCE: The inspectors observed that substantial work is being undertaken to improve the environment of the home. Service user bedrooms were comfortable but often untidy. There are plans to provide cupboards in the en-suites for pads. Managers and staff should discuss systems that would enable staff to take responsibility for the appearance of the rooms of very frail service users. For example a key worker system that included the allocation of rooms to staff. The home employs a team of domestic staff and on the day of the inspection the cleanliness of the home was good. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 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 recruited to augment the established core of staff. The appointment of a full time deputy manager will greatly assist the manager. 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 parttime staff in the home, which can make continuity of care an issue. The manager is taking measures to overcome this. Staff have received manual handling and fire training. Staff spoke positively about the NVQ training programme that is being implemented. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 and 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 Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 18 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. An immediate requirement was issued to ensure all rails comply with the MDA guidance. PORTABLE APPLIANCES – This will be checked at the next inspection. ACCIDENTS – The home maintains records relating to accidents at the home. Records show that a high proportion of accidents occur at night. The manager plans to begin an analysis of these on a monthly basis to identify any traits. This will be followed up at the next inspection. 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 Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 1 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 x x 2 x x 3 Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? N/A. 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 OP 3 OP 7 Regulation 14 (1) 15 Requirement Pre-admission assessment must be fully documented. Care plans must be fully completed and signed. They must reflect the full range of service users needs and must give clear directiuon to staff of the action to be taken to meet these needs. Medication records must be completed as directed in the immediate requirement letter. An assessment of bed rails in the home must be undertaken in line with MDA guidance. Staff must receive training in the care of service users with degrees of dementia. The training must include practical guidance in reducing anxiety and improving communication with service users. Timescale for action 1/11/05 1/12/05 3. 4. 5. OP 9 OP.38 OP.4/30 13 (2) 13 (4) c 18 (c) Immediate Immediate 1/12/05 6. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 21 No. 1. Refer to Standard OP.12 Good Practice Recommendations A programme of social activities based on the requirements of service users must begin. Axbridge Court Nursing and Residential Home D53 - D02 S64451 Axbridge Court V224824 080905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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