Inspection on 19/04/05 for Abbeywood Care Home

This inspection was carried out on 19th April 2005.

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

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

Other inspections for this house

Abbeywood Care Home 21/07/09

Abbeywood Care Home 28/08/07

Abbeywood Care Home 05/05/06

Abbeywood Care Home 05/10/04

Abbeywood Care Home 20/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE 3 Ribble Road Fleetwood Lancashire FY7 7BX Lead Inspector Janet Spink Unannounced 19 April 2005 9:00am 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. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ribble Lodge Nursing Home Address Ribble Road Fleetwood Lancashire FY7 7BX 01253 776761 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) Dr Shanmugam Subbish CRHN Care Home with Nursing 28 Category(ies) of DE Dementia 28 registration, with number of places 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5 October 2004 Brief Description of the Service: This home is registered for twenty eight residents who are over sixty five. It offers nursing care to people who have dementia. It is in Fleetwood and in easy reach of shops and the promenade. The home is built on two floors and has a passenger lift for those who need it. The home has eight single bedrooms and ten double rooms. There are no ensuite facilities. There is one large loung/dining area and a separate room for people who smoke. There is also a small external sitting area at the rear of the building that can be used by people who use wheelchairs. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and carried out by two inspectors and took place over seven hours. The inspectors returned the following day to share their findings with the acting managers. This was also fed back to the owner on a separate day. The inspection involved case tracking four residents, discussions with five members of staff, discussions with five relatives and the manager. A partial tour of the building was also undertaken. Most evidence was gained from staff and relatives due to service users having dementia. There has been a complaint made since the last inspection, which is currently being investigated by the registered provider. The home has been visited on two occasions since the last inspection to monitor recruitment practices. The pharmacist inspector has visited three times to monitor practices in relation to medication. What the service does well: What has improved since the last inspection? 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 Information before admission is not always given to residents. Some progress has been made to improve the admission procedure to ensure that there is a proper assessment carried out before people move in to the home. Without this information there are no assurances care needs will be met. EVIDENCE: Four files were looked at to see what information had been collected by the manager before admitting someone in to the home. Three of the files had detailed assessments completed by another professional such as a nurse or social worker. They also included an assessment that had been carried out by the matron of the home, which included information such as dietary needs, social needs, mobility and communication. These three files also held letters confirming that the home could meet the resident’s needs. The fourth file showed that the matron had not carried out an assessment until the day of admission. There was no assessment done by a social worker or hospital representative so the resident was admitted without the home having sufficient information to ensure it could meet the needs of that person. One relative 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 9 spoken to told the inspector that they were not aware of any written information about the home and did not know about terms and conditions 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 11. The care plans are not consistent in giving sufficient information to staff so they can meet residents’ needs. EVIDENCE: Care plans are available for all residents, but these were not consistent in giving information about health, personal and social care. This was particularly evident for one resident who had a pressure sore noted on one date, however the care plan was not updated until four days later. Some care plans were more detailed than others about nutritional assessments, risks of falling and risk of developing pressure areas. Service users’ wishes following death should be recorded on care plans. Discussions with staff again showed inconsistency about their knowledge of individuals as they were aware of which residents need a soft diet and who needs two carers to assist them, however did not know that one lady has epilepsy. Residents are at risk if not having their care needs met if staff do not know about individual problems. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 11 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) 12,15 Social activities are limited and residents would benefit from their individual needs being given more consideration. Meals are well balanced and offered in a relaxed manner with appropriate help being given. EVIDENCE: Menus were looked at found to be varied and nutritious, with special diets such as diabetes being catered for. The inspector sat in the lounge at lunch time and saw residents being helped in a caring and sensitive manner. meals were seen to be nutritious as fresh fish and vegetables were being served. Residents were not rushed and this time was used for staff to interact with them. Relatives were spoken to who commented that the food is of good quality and the portions are large. Through discussions with the manager the inspectors found that social interests are recorded on care plans, but there is little encouragement for individuals to pursue these hobbies or interests. The inspector saw that one resident enjoys carrying a baby doll with her at all times and this was introduced to her by the home. Her relative said that this has been positive for her as it sometimes relaxes her when she is agitated 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 12 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) 17,18 There has been no progress on staff training in respect of vulnerable adults procedure to ensure a proper response to any suspicion or allegation of abuse EVIDENCE: Staff told the inspectors that they have not been given any formal training for the causes of abuse, types of abuse, recognition of abuse, and reporting of suspected abuse. This was brought up during the last inspection and must be addressed by the managers to ensure the safety of the vulnerable residents living in the home. The whistle blowing policy must also be encouraged to stop staff being reluctant to report concerns because of fears of repercussions. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 13 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) 21,22,23,24 The standard of the environment is good providing residents with a safe and homely place to live, but this could be improved by the provision of adjustable beds for those who need nursing. EVIDENCE: The inspector looked around the building and could see that no adjustable beds are provided for people requiring nursing care. Staff spoken to told the inspector that this would assist them in looking after residents who need personal care as it would make moving and handling easier and safer. The inspector also noted that the bathroom on the first floor is not being used and all residents use the ground floor bathroom even if their bedroom is on the first floor. This is because there is no hoist on the first floor. It would benefit residents if this bathroom had an assisted bath or shower provided so they do not have to go as far to be bathed. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 14 The home is comfortably furnished and well decorated. Bedrooms have personal possessions including photographs and ornaments ensuring that it is homely. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 15 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) 27,29,30 The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. Staffing levels are adequate in meeting the needs of residents, but this is reliant on agency staff. EVIDENCE: The staff files of three staff members indicated that the manager has not undertaken all the necessary recruitment checks to ensure protection of residents. One staff member had been offered a job despite having two poor references, and one overseas worker did not have evidence of a work permit at the time of the visit. Staffing levels meet with the staffing notice, but one staff member said “there isn’t enough time to take people out. At the time of the visit there were two manager on duty, three carers, a cook and the domestic. Staff training has improved recently as there are five members of staff on NVQ level II. Due to the needs of residents’ training should be provided for epilepsy and dementia. Staff said they have not had this training. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 16 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 and 32 The manger has recently withdrawn her application to become registered with the Commission, and plans to leave the home in June 05. This means that the registered provider must address recruiting and selecting a replacement for her. Discussions with staff found that they do not have confidence in the present manager or her leadership skills, which several staff feel has resulted in poor morale. Communication was poor between staff and the manager meaning that they do not always have the information required to meet people’s needs. EVIDENCE: 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 17 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 1 1 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x 1 3 3 1 x x STAFFING Standard No Score 27 2 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 2 1 1 1 1 x x 1 x x 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 18 Yes 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 OP2 Regulation 5 Requirement Terms and conditions must be provided for service users. A copy of this must be supplied to the resident and a copy maintained on the file. These must be signed by the resident or their represetative and the manager of the home. Employment procedures must be more robust and staff must not be employed until all checks are completed. Staff records relating to training and incudtion must be kept on the premises and made for inspection. The registered provider must visit the home once a month unannoucned and perform an inspection of the premises and facilities. A copy of the report must be suppliied to the Commission. The registered person must ensure that proper provision is made for the health and welfare of the residents, taking into account risk assessments with regard to moving and handling, Timescale for action 31/05/05 This timescale has been extended 2. OP29 19 3. OP30 17 4. OP33 26 31/05/05 This timescale has been extended 31/05/05 This timescale has been extended 31/05/05 This timescale has been extended 31/05/05 This timescale has been extended Page 19 5. OP8 12(B) and 13(5) 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 6. OP18 13(6) tissue viability and the prevention of falls. All staff must receive training in abuse to ensure that service users are not placed at risk from harm or abuse. 7. OP1 4 8. OP30 18 9. OP18 12(2) 10. OP18 13(6) 11. OP24 12(1)(a) 12. OP12 16(2)(n) 13. OP32 8(1)(a) 14. OP21 23(j) 30/06/05 This timescale has been extended The Statement of Purpose and 31/05/05 Service user Guide should This containe all information specified timescale in Schedule 1 as epiepsy and has been dementia. extended All staff must receive appropriate 30/06/05 trianing for the work they are to This perform such as epilepsy and timescale dementia. has been extended The Abuse Policy must be 31/05/05 updated. This timescale has been extended Staff must be aware of the 31/05/05 Whistleblowing policy and the This importance of reporting timescale concerns. has been extended The Registered Person must 31/05/05 ensure that all equipment including beds are fit for purpose. The manager must ensure that a 31/05/05 programme of activities is This implemented in the home, which timescale meet individual needs of has been residents. extended The Registered Provider must 19/07/05 ensure that a manager is registered with the Commission as the registered person is not in day to day charge of the running of the home. An assisted bathing facility or 19/07/05 shower must be provided on the first floor to give residents choice about which facility they use. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP11 OP13 OP17 Good Practice Recommendations Residents wishes following death should be recorded on the care plana and where this is not appropriate, representatives involvmetn should be recorded. A visitors policy should be available that is included in the Statement of Purpose and Service User Guide. An advocacy policy should be available in the Statement of Purpose and Service User Guide. 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Area Office, Unit 1 Tustin Court Portway Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI 3 F57 S6076 Ribble Lodge V210653 180405 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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