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Inspection on 18/04/07 for Somerset Abbeyfield Extra Care Home

Also see our care home review for Somerset Abbeyfield Extra Care Home for more information

This inspection was carried out on 18th April 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The inspector spoke to 9 service users and all commented on the helpfulness and support they receive from the staff. Comments included "Staff are wonderful", "You couldn`t get better staff than here". Surveys received also confirmed that staff treat service users with sympathy and care. One comment made was "The staff are caring and supportive" and "I am very well looked after" The inspector observed that service users have access to a variety of activities and are supported to maintain any activity preferences. Service users are able to choose whether to join in with activities or to pursue their own interests. Service users were seen moving freely around the home and the gardens, supported as required by staff. All service users appeared well cared for and detail to personal appearance was evident. The standard of hygiene in all areas of the home was excellent. There was a good standard of furnishings and fittings throughout the home and the use of several lounge areas supported a homely feeling. It was noted that several service users self-administered their medication and those spoken to stated that this was their choice and that it had been fully discussed with them. Appropriate documentation was in place in respect of service users who self-administer medication and safe storage facilities are provided in personal rooms. Staff spoken to felt were all positive about the management style of the home. All felt supported and were comfortable to take any concerns to their supervisors. Staff confirmed that training opportunities are ongoing.

What has improved since the last inspection?

The provision of bathrooms in the special care unit has been reorganised to ensure service users privacy and dignity. Service users no longer walk through the dining room to access the bathroom. Hand washing facilities have now been installed in all bathrooms. The lunchtime menu now offers a choice of meals to all service users. Service users were happy to confirm that there is always a wide range of choice. Pre admission assessments were now evident in the personal files.

What the care home could do better:

Care plan files require further input to ensure that all areas of assessed needs have an appropriate care plan. Further detail is required within these care plans to support care staff to identify and maintain all areas of service users care needs. Staff must ensure that 2 staff members sign all hand transcribed medications. This is required to be maintained to prevent risk of error in hand transcribing medications. It is recommended that the Homely Remedy Policy is reviewed and updated. Whilst staff confirmed that they receive supervision regularly no records of this had been maintained. Supervision records for staff must be maintained up to six times per year and covers the topics identified in the National Minimum Standards. The registered manager is required to ensure that all documents listed in Schedule 2 of the Care Homes Regulations 2001 are maintained in staff files to ensure the recruitment procedures of the home protects service users from the risk of abuse. The registered manager is recommended to ensure that all accidents are suitably recorded to enable regular auditing to take place.

CARE HOMES FOR OLDER PEOPLE Somerset Abbeyfield Extra Care Home Heron Drive Bishops Hull Taunton Somerset TA1 5HA Lead Inspector Gail Richardson Unannounced Inspection 18th April 2007 09:30 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 Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Somerset Abbeyfield Extra Care Home Address Heron Drive Bishops Hull Taunton Somerset TA1 5HA 01823 334238 01823 334238 sa3345@eclipse.co.uk 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) ABBEYFIELD (SOMERSET) SOCIETY Limited MS JILL BYFORD Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (10) of places Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. REGISTERED FOR 10 PERSONS IN CATEGORY OP AND 22 PERSONS IN CATEGORY DE (E) 9th February 2006 Date of last inspection Brief Description of the Service: Abbeyfield is an independent home within the national Abbeyfield Society, which is a registered charity. The registered manager is Jill Byford. The home is registered with the Commission for Social Care Inspection to provide care to up to 32 people over the age of 65. The home specialises in the care of older people who have a dementia and provides up to 22 beds for this service user group. The property is purpose built and provides ground floor accommodation for all but three of the service users. The home is divided into two parts, a 14 bedded unit for people with advanced dementia and a 18 bedded unit for older people. All areas of the home are well maintained and pleasantly furnished. The current fee scale ranges between £396 to £458, extra charges are made for hairdressing, chiropody, newspapers and trips out. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by Regulatory Inspector Gail Richardson, which took place over one day (8 hours ) on the 18th April 2007. A tour of the home took place and all the bedrooms and communal areas were seen. There were 32 service users currently residing at the home with 14 service users in the Special Care Unit and 18 in the main body of the home. On the day of inspection 3 day-care visitors were at the home. The inspector spoke to 9 service users, 11 members of staff and the registered manager was available throughout the inspection. As part of this inspection the inspector surveyed the opinions of a random selection of service users and their representatives, GP’s, District Nurses and staff. A good amount of responses were received and these responses are noted within the inspection report. Records relating to care, staff, finances and health and safety were examined The inspectors noted that service users appeared settled and comfortable and the home appeared calm with a happy atmosphere. Service users who were able, were unanimous in confirming that they enjoyed being at the home. Staff spoken with, felt able to express any concerns about working in the home and all confirmed that they enjoyed working at the home. Time spent by the inspector observing staff, evidenced that they were kind and caring towards service users and spoke to them with support and reassurance. Current building work at the home is taking place to extend a further 6 apartments. Whilst some disruption to service users and staff is inevitable, efforts have been made to manage the build with the minimum of disturbance to service users and the registered manager of the home confirmed that completion is planned in the near future. The inspectors would like to thank the service users and staff for their time and hospitality through out the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 7 Care plan files require further input to ensure that all areas of assessed needs have an appropriate care plan. Further detail is required within these care plans to support care staff to identify and maintain all areas of service users care needs. Staff must ensure that 2 staff members sign all hand transcribed medications. This is required to be maintained to prevent risk of error in hand transcribing medications. It is recommended that the Homely Remedy Policy is reviewed and updated. Whilst staff confirmed that they receive supervision regularly no records of this had been maintained. Supervision records for staff must be maintained up to six times per year and covers the topics identified in the National Minimum Standards. The registered manager is required to ensure that all documents listed in Schedule 2 of the Care Homes Regulations 2001 are maintained in staff files to ensure the recruitment procedures of the home protects service users from the risk of abuse. The registered manager is recommended to ensure that all accidents are suitably recorded to enable regular auditing to take place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 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 Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 3 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide is currently being updated to include the new building work taking place. The home continues to be able to provide prospective service users and relatives with sufficient information for them to make an informed decision about the home. All prospective service users receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. EVIDENCE: The registered manager explained that the statement of purpose and service user guide are currently being updated to include the new building taking place. The manager ensures that prospective service users and relatives have Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 10 sufficient information about the home through discussion and visits to the home. 6 service users surveys received, felt that they had received enough information prior to admission, 2 did not. At inspection 2 service users, who were asked, confirmed that they had visited the home prior to admission. One comment received from a relative survey was, “Staff were most helpful and all family members visited the home before ……. admission” and “ My daughter visited the home first, then I visited to see what it was like and decided to stay for a trail period”. Contracts provided to service users contained all the relevant information required. 4 service user surveys confirmed that contract had been received and 2 said they had not. Detailed pre admission assessments were available for the 3 service users who the inspector case tracked. All prospective service users complete an application form about themselves and their needs and this is retained in the service users care plan. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user has a care plan, however in the cases examined at inspection, the assessed areas of need were not all reflected in the plan of care. Despite this the staff appear to provide the care required and the outcomes for service users appeared to be good. The management of medications systems was mostly good, hand transcribed entries on the Medication Administration Records were not all signed by 2 staff members. Staff were observed to treat service users with dignity and respect. EVIDENCE: The inspector case tracked 3 service users from pre-admission to care planning and included documents relating to medication, accidents and finances. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 12 The areas identified at pre admission were not all reflected within the care plan and may present a risk of service users not receiving the range of care required. Some areas, which had been identified, did not give sufficient detail to ensure staff would be aware of all aspects of care required. Reviews had been undertaken but were not all dated and there was no evidence of the involvement of service users or their representatives in the care planning process. On observing the staff, the inspector was aware that the care was being given and recorded in the daily record. This was discussed with the manager at inspection and the manager confirmed that whilst staff had undertaken care plan training further instruction in care planning was required. 7 staff surveys confirmed that they were clear about service users needs before visiting them. It was also discussed that the daily record of care given is currently being recorded on loose-leaf lined paper in the service users file, which does contain the service users name or the name of the home. The registered manager reassured the inspector that she would rectify this immediately. When asked, do you receive the care and support you need, Service user surveys said 6-always,1-usually. One comment received was “I am very pleased with the kindness and quality of the care being received”. When asked by survey, do the staff listen and act on what you say, 7 said always. All service users are registered with local GPs and other relevant healthcare professionals. All appointments are recorded and show that people are accessing chiropodists, dentists, community nurses and other services appropriate to their individual needs. When asked by survey, if service users receive the medical support they need, 7 said -always. The home has a good working relationship with the district nurses who attend the home regularly. One comment received from a local surgery was “Superb care, excellent staff “ and all 3 responses from GP surgeries stated that they were happy with the overall care provided to service users within the home. The home uses the Boots Monitored Dosage System for medication and staff who administer medication have received training from the dispensing pharmacy. Medication is stored and administered separately in the special care unit and the main part of the home. The inspector viewed medication in both units. There is suitable storage for all medicines, including controlled drugs and medication that requires refrigeration. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 13 The management of the medication systems were mostly satisfactory. In 4 instances the hand transcribed medications noted in the Medication Administration Records in the Special Care Unit had not been signed by 2 staff and in some cases had not been dated. This practice is required to protect both service users and staff from the risk of error in transcribing. This issue had previously been identified and noted by the visiting Community Pharmacist in June 2006. It was also observed that the recording of prescribed creams on the Special Care Unit was variable. One service user had cream which was named and dated when opened but was not recorded on the Medication Administration Records. Service users have the option to self medicate should they want to. Suitable documentation was in place in respect of these service users and all had safe storage within their rooms. A homely remedy policy is in place and some stock is available on the Main Unit, the policy was last reviewed in 2002 and is recommended to be reviewed and updated. All service users who were able to express their views stated that their privacy was respected and that they were assisted with personal care in a sensitive manner. The inspector observed that staff interacted with service users in a respectful friendly manner. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a wide range of opportunities for social stimulation and service users are supported to join in with organised activities or pursue their own interests. The meals in the home are of a good quality and a wide range of choice is available. EVIDENCE: The inspector spent time chatting with service users and observed service users moving freely around the home and garden area. Service users stated that there were no strict routines in the home and that they were free to decide how and where they spent their time. Everyone who expressed an opinion stated that they have choice about all aspects of their care and are comfortable to request any particular preferences. Monthly service user meetings take place which are well attended and used as an opportunity to express group opinions. Minutes of these meeting showed that a variety of subjects are discussed and that action is taken to address any issues arising. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 15 Care plans evidenced preferences of activities and stated service users choices of what time to get up and go to bed. The activity organiser stated that there are a variety of organised activities including shopping trips, regular entertainers, quizzes, bingo, arts and crafts, film shows and social events. The activity organiser is about to qualified in July 2007as a Creative Activity Therapist through Reminiscence Learning. On the day of the inspection the inspector observed that some people spent time in their rooms, some were chatting in the communal areas, bingo was being played in one lounge and several service users were observed out for a short walk. A shop was in progress during the morning selling sweets and toiletries, a trip to Exeter was planned for later in the day for service users from both units and the hairdresser was seen working in a small salon for the Special Care Unit. Armchair Theatre was also planned by an external entertainer for the main unit that afternoon. Planning of activities is made by discussion with service users of their preferences and the home strives to support service users in activities of their choice. Many people stated that they are free to choose which activities they join in with and which they do not. Surveys asking if there are activities arranged by the home that you can take part in responded 1-always,2-usually,3sometimes. Religious service is provided monthly and access to visiting clergy is arranged as requested. Service users stated that friends and family are made welcome at all times. Staff were observed to interact well with service users in both units of the home and the relationships between staff and service users appeared relaxed and good humoured. Staff displayed a good understanding of service users needs. On both units there are TVs, radios, books, magazines and newspapers. A wide range of board games are also available. The care staff provide breakfast each morning, the main meal of the day is at lunchtime and there is a pleasant dining room on each unit. On the main unit the tables were nicely laid with a choice of condiments and drinks to have with their meals. In the special care unit the meals are served on plates placed on small trays at the dining table. Staff explained that service users were happy with this practice and it assisted the service users to be able to locate utensils and be clear about what equipment to use. There is a choice of meal at both lunch and teatime. Service users confirmed that if both choices were not suitable an alternative could be arranged. It was Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 16 observed that some service users enjoy having a fridge in their rooms and are supported to enjoy this independence. Service users stated that the quality and choice of the food was very good. Comments included “the food is very nice”, “Lovely food, plenty of choice”. Only one comment was received that the food was “very bland”. Service users surveys asked, do you like the meals at the home, 4-always, 1-usually. On the day of inspection lunch was a choice of roast chicken, potato and a selection of vegetables or and cheese and ham omelette with salad. Desert was Vienetta ice cream or an alternative of choice. Tea was Fish Fingers/spaghetti, sandwiches and fruit whip and supper was noted on the notice board to be cheese and biscuits. The inspector observed lunch being served in both units and it appeared to be enjoyed by all. Service users who required assistance were helped in a dignified and discreet manner. Service users with specific dietary needs and preferences were catered for and contact with the Community Dietician is made as and when required. The inspector visited the kitchen and noted an excellent standard of hygiene, it was discussed with the registered manager that jelly stored in the fridge did not indicate a date of use and is required to do so. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and service users are confident that the homes management team would appropriately deal with any complaints or concerns. Policies and procedures are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing, staff training in abuse awareness has also taken place. Staff comment cards confirmed that staff are aware of the policies in place to prevent service users from the risk of abuse. Staff surveys asked staff if they were aware of information about protecting vulnerable adults and how to report concerns about poor care practice and allegations of abuse.6-yes,1-no. Due to the updating of the homes service user guide the complaints procedure is not supplied at pre admission assessment or displayed in the home. The registered manager confirmed that she would arrange for the display the complaints procedure in the front hall. The home does not currently have a complaints log as the registered manager explained that no complaints have been made. Service user surveys asked do you know who to complain to if you are not happy and 7 said always. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 18 6 stated that they knew how to make a complaint and 1 said no. One comment received was “Any concerns have been addressed promptly”. Some areas of the home are locked by electronic keypad and all people living in this unit have been assessed as requiring this level of security. Service users all have unrestricted access to outside space and people living in the special needs units are able to use other areas of the home to take part in activities. Service users stated that they would be comfortable to approach the manager or a member of staff with any worries or concerns. One service user stated that you could always speak to staff or go to the manager’s office. The inspector observed that service users feely visited the manager’s office during the inspection. All service users are registered to vote and have the option of a postal vote or can be assisted to the polling station. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Abbeyfield provides a comfortable and clean environment which meets the needs of the service users. EVIDENCE: The home is divided into two units, the main body of the home has accommodation for 18 service users with personal care needs. The Special Care Unit has accommodation for 14 service users with dementia care needs. Each has its own communal lounge and dining area, the special care unit also has a large conservatory and at the main entrance to the home there is a comfortable seating area. All communal areas are well furnished and decorated. With the exception of three bedrooms all personal accommodation and communal areas are located on the ground floor and are accessible to people Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 20 with all levels of mobility. Stairs and stair lift can access the three upstairs bedrooms. All bedrooms seen by the inspector were comfortably furnished and had been personalised to reflect the tastes of the individual service user. Service users are able to bring personal effects and small items of furniture with them when they move to the home, which gives rooms an individual homely feel. Service users confirmed that they had chosen their rooms or had been offered a change of room when rooms had become available. En- suite facilities were available in all bedrooms. All service users who were asked were pleased with the accommodation at the home. Various aids and adaptations have been put in place to assist service users to maintain their independence. There are handrails to assist with physical mobility and clear signage to help people to orientate themselves. It was noted that a system of arrows had been positioned to assist a service user find their way around, this system shows initiative by the staff to support the service user to maintain their independence. Call bells are fitted throughout the home. The home is currently being extended to include 6 further apartments. This building work has been managed to minimise disruption to the service users. The garden area at the rear of the home has been undisturbed and service users were seen to have some access at the front of the home. The standard of hygiene in the home was extremely good, on the day of inspection, 2 cleaning staff were on duty and explained the routine cleaning and deep cleaning programme to maintain this high standard of cleanliness. No malodours were evident within the home. Service users surveys asked if the home was clean and fresh, 7-always One comment received was “Very good regular cleaning” and “I am impressed by the general level of cleanliness”. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are adequate to meet the assessed needs of service users and staff training is promoted to support service users. EVIDENCE: The inspector examined staff rotas for the week of the inspection and discussed with staff and service users their views on staffing levels. Both staff and service users were confident that staffing levels were adequate to meet the needs of the service users. On the day of inspection there were 5 staff in the Special Care Unit and 4 care staff plus the manager on the Main Unit. There were also 2 domestic staff, 1 administrative staff, 2 cooks, 1 kitchen staff and 1 laundry staff. A minimum of 5 staff were available on each unit throughout each day and 2 staff were available overnight. The home also has an on call system should further assistance be needed. 7 service user surveys were received and all stated that staff were available when needed. One comment was “Especially the senior staff “.and “Always very co-operative on the telephone”. Requests for assistance were observed to be responding to promptly by staff in a pleasant manner. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 22 All service users were complimentary about the staff, one comment received was “ I am very pleased with the kindness and quality of care my relative is receiving”, another service user said “All the staff are wonderful” and “The staff are all very nice”. Staff recruitment procedures were mostly satisfactory. Two files lacked a photograph and another file lacked copies of certificates previously achieved. The registered manager is recommended to ensure that all documents listed in Schedule 2 of the Care Homes Regulations 2001 are maintained in staff files. Staff confirmed that mandatory training and regular updates are ongoing for all staff .One new member of staff was about to commence the Common Induction Standards induction whilst another new staff who has previous care experience is undertaking the Service Specific Induction Training. 7 Staff surveys received said that all staff felt they had received adequate induction and supervision. 6- staff comment cards stated that staff were always clear what duties you must not undertake, 1 was not. Staff have received training in aspects of caring for older people with physical and mental health needs. The manager confirmed that 75 of the staff employed had achieved a National Vocational Qualification in care. Staff comments received included “It is a very enjoyable place to work “ and” We are always updated as to the needs of clients”. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 37 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and responsibilities appropriately delegated. The registered manager is required to ensure further supervision of those delegated responsibilities. Systems are in place to ensure the health and safety of service users whilst encouraging and promoting independence. EVIDENCE: The registered manager of the home is Jill Byford who has managed the home for over twenty years. Discussions with the inspector confirmed that she has a clear understanding of the needs of the service users living at the home. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 24 Service users who were able, confirmed that they had great confidence in the registered manager. Some areas of responsibility are delegated to the heads of each unit and the unit manager oversees the day-to-day care and offers support and guidance to care staff. These heads of care appeared knowledgeable and competent about the care needs of the service users. Staff spoken to stated that there was good communication between the managers and staff team. Staff confirmed that meetings take place twice a year and minutes of these meetings are posted on the notice board at the home. Should issues be raised in the interim, staff confirmed that senior staff meet regularly and any concerns raised can be taken and discussed then. Staff felt confident that their issues would be listened to, taken seriously and addressed. The home sends out questionnaires to all service users/relatives yearly. This was last done on 12 months ago. Questionnaires received had complementary comments regarding the environment and care given. A letter from a relative was available and commented, “I am convinced that I would have found no better, more caring home “. There are established systems in place for dealing with service users finances. The inspector evidenced that each service users personal monies were stored in individual envelopes with a running total of deposits and withdrawals. All service users records are stored confidentially in line with the Data Protection Act. The Registered Manager explained that unit managers are responsible for supervising a number of care staff each. Staff confirmed to the inspector that they regularly receive supervision, however records of this supervision content or regularity have not been maintained. The registered manager confirmed that she had not overseen the records of supervision which have not been maintained since January 2006and is required to do so. Accident records were examined and reflected that not all accidents noted during case tracking had been recorded in this log. The registered manager explained that this was due to the frequency of accidents in this instance. The inspector advised that the recording of all accidents in this format is required to audit for trends and incidences of place, time and related factors. The certificates displayed in respect of insurance were noted to have expired on December 2006. The registered manager will address this issue immediately. A handy man is employed and all areas seen appeared well maintained. Comprehensive maintenance records were seen. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 25 These included : * Fire Extinguishers * Hoist Servicing * Emergency lighting * Gas Servicing * Electrical Hard Wiring * Fire System * Pharmacy reports * Environmental Health * Weekly fire tests * Staff fire drill * Staff Fire Training * Fire Extinguisher servicing * Fire Risk Assessment * Weekly Bath Temperatures Portable appliance Testing records were not available and are to be forwarded to the CSCI offices. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 26 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 X 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 2 3 Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no 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 (1) Requirement The registered manager shall, after consultation with the service user, or a representative of his, prepare a written plan- as to how the service users needs in respect of his health and welfare are to be met. The registered manager is required to ensure that care plans accurately reflect the assessed needs of the service user. 2. OP9 13(2) All hand transcribed entries to the Medication Administration Records must be signed by two staff and dated. All prescribed creams must be signed for when used on the Medication Administration Records. 3. OP29 19(1)(b)(i )Schedule 2 The registered manager is required to ensure that all documents listed in Schedule 2 of the Care Homes Regulations 2001 are maintained in staff files. DS0000016046.V334782.R01.S.doc Timescale for action 30/07/07 30/04/07 30/04/07 Somerset Abbeyfield Extra Care Home Version 5.2 Page 28 4. OP36 18(2) The registered manager must ensure that records of staff supervision are appropriately maintained to ensure staff receive supervision 6 times per year and cover the topics outlined in the National Minimum Standards. 30/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 3 Refer to Standard OP9 OP37 Good Practice Recommendations It is recommended that he Homely Remedy Policy is reviewed and updated. The registered manager is recommended to ensure that all accidents are suitably recorded to enable regular auditing to take place. Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Registration Team Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Somerset Abbeyfield Extra Care Home DS0000016046.V334782.R01.S.doc Version 5.2 Page 30 - 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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