Inspection on 01/04/10 for West Abbey House

This inspection was carried out on 1st April 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Abbey House 21/01/10

West Abbey House 19/11/09

West Abbey House 05/08/09

West Abbey House 30/01/08

West Abbey House 04/07/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Random inspection report Care homes for older people Name: Address: West Abbey House Stourton Way Yeovil Somerset BA21 3UA one star adequate service 21/01/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Justine Button Date: 0 1 0 4 2 0 1 0 Information about the care home Name of care home: Address: West Abbey House Stourton Way Yeovil Somerset BA21 3UA 01935411136 01935420829 westabbey@barchester.net www.barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Barchester Healthcare Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 97 Number of places (if applicable): Under 65 Over 65 0 55 0 dementia old age, not falling within any other category physical disability Conditions of registration: 32 0 10 The maximum number of service users who can be accommodated is 97. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum of 32 places Physical disability (Code PD) maximum of 10 places Old age, not falling within any other category ( Code OP ) maximum of 55 places Date of last inspection 1 9 1 1 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home West Abbey is located in a residential area on the outskirts of Yeovil. It was purpose built as a nursing home in 1994. In the main building is a 66-bedded unit for service users requiring general nursing care and this is located on two floors. There is one 13-person lift to the first floor. The corridors are wide and can accommodate people who mobilise using a wheelchair. The home has accessible and pleasant garden areas. The majority of the service users in the main wing are older people. The home is also registered to take up to 10 younger people (18-65). In a separate wing there is a single storey 28 bedded unit (Lyde) for older people with mental health needs. The Lyde unit has its own central courtyard garden. The homes current fees are £550 per week plus free nursing care,and for younger people fees are in line with their individual care needs assessment. Care Homes for Older People Page 3 of 10 What we found: This inspection was carried out on 1st April 2010, by two inspectors. The purpose of this visit was to review progress towards meeting requirements and recommendations made at previous inspections. The visit was also conducted in response to continued concerns raised by visiting professionals including community nurses, social workers and care managers. In addition the visit reviewed the care records relating to a a specific incident regarding one individual who lived at the home. At previous inspections it has been confirmed that the care records do not always reflect the care needs of people living at the home. This has also been confirmed by visiting professionals who visit the home. During this inspection we reviewed the care records of five people living at the home. Some progress was seen with regard to the care plans and assessments in some care plans whilst others did not to reflect the care needs of the individuals. In addition the care plans for one individual involved in a specific incident at the home were viewed as part of an ongoing investigation. The care records for two individuals with wounds or pressure ulcers were viewed. These showed that for individual the care records gave clear guidance to the staff on the progress and treatment of the wound. This is an improvement on previous inspections. For the second individual care records for the management of the wound was poor. The care plan detailed the inappropriate use of foot protection. The advise given in the care plan was observed to followed by staff on the day of the inspection. The inappropriate use of the foot protection could have impacted on the healing of the wound. The care plans did not give clear guidance on the treatment or size of the wounds. The plans were confusing as the individual had more than wound and you could not ascertain which documents related to which wound. During the inspection care records for another individual were viewed. This individual had recently been diagnosed as having pneumonia. There was no care plan for this aspect of the individuals needs. In addition people who have a chest infection or pneumonia should be sat as upright as possible to aid breathing. We observed the individual lying flat in bed during the morning of the inspection. This issue was raised with the management at the home at the end of the inspection. The other care plans viewed showed some improvements with a up to date range of assessments and plans which clearly reflected the needs of the individuals. These were an improvement on previous visits On reviewing the care plans,however we found that these documents were large and cumbersome. Visiting professionals have also commented on this. As the care records contain a large amount of information it is very difficult to find information quickly and information which is current. The management at the home need to review these comments. During the visit we observed that two people (previously described) were not receiving the care and support they required in line with best practice and in line with their assessed needs. In addition there is an ongoing investigation with regard to the care and support received by one individual at the home. As a result of this and the ongoing Care Homes for Older People Page 4 of 10 concerns being received by the PCT and Adult Social Care we requested an update on the recent training completed by the registered Nurses. The training matrix supplied was viewed following the inspection. The home employs 18 registered nurses. Of these only five have received training on PEG feeding, only two staff can take bloods, three staff have undertaken updating training on diabetes and one for Tissue viability. Six staff have undertaken training on challenging behaviour or Barchesters dementia training. Given that that the home has a diverse and a high number of people with specialist needs including younger people, people with high nursing needs and those with dementia the current nurse training is not adequate. It could not be confirmed that a number of the nurses have completed sufficient training to meet the Nursing and Midwifery guidelines. The management now need to ensure that the trained nurses have the skills and competencies to meet the needs of people living at the home. Some significant improvements were viewed during the visit. At previous inspections it had been found that people did not have access to fluids particularly hot drinks. In addition for some people who had lost weight or were at risk of loosing weight it could not be confirmed that staff were taking appropriate action. During this visit all care plans viewed contained information with regard to peoples diet and fluid requirements. This included a nutritional assessment. People who were at risk were having their diet and fluids robustly documented. Where shortfalls in intake were noted staff were taking appropriate remedial action. On this occasion all people at the home had a hot drink offered during the morning, with meals, afternoon and evening. The drinks are served by the hospitality staff. This continues to be an issue for those people who require staff support to drink. Care staff were not always available to support people when the drinks were served. The care staff and hospitality staff need to liaise to ensure that drinks are not served unless staff are available to support people. At previous inspections it has been noted that people did not always have access to a nurse call bell or any means of attracting staff attention. At this inspection t was noted that staff now have a robust system of ensure checks on those people who cannot use the nurse call bell system. Concerns had been raised to us with regard to the managerial arrangements at the home. The registered manager has recently left employment. During the inspection visit we discussed the interim managerial arrangements. These appeared to be satisfactory. We spoke to the deputy manager on the day of the inspection visit who is newly employed at the home. He stated that he felt well supported by the company and had received a full induction to his role. During the inspection we were informed that a new manager had been recruited and would be in post in the very near future. During the inspection visit we requested the staff rotas. These were viewed following the inspection. These demonstrated that sufficient staff were on duty for the general needs of people at the home. As previously stated however it could not be confirmed that the qualified Nursing staff have the skills and competencies to meet the needs of people living at the home. In addition we have been made aware that a number of people at the home are receiving funding for periods of one to one care and support. It could not be confirmed that the current staffing arrangements are adequate to meet these requirements. We viewed staff recruitment files. These were seen to be of a good standard and included evidence of supervision arrangements for one staff member Care Homes for Older People Page 5 of 10 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans are regularly reviewed and remain fully reflective of peoples current assessed needs This is to ensure peoples assessed needs are met by staff. 08/03/2010 2 7 15 (1) The registered person 01/03/2010 must ensure that a plan of care is raised to address peoples assessed needs and that care is delivered in line with the plan of care This is so that people receive care in line with their assessed needs. 3 8 12 (1) The registered person 01/03/2010 must ensure that appropriate care plans are raised for the management of peoples pressure sores. This is to ensure that people receive the necessary treatment required. 4 36 18 (2) The registered person must ensure that all staff receive formal supervision. This should be at least six times a year. 30/04/2010 Care Homes for Older People Page 7 of 10 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to ensure that staff receive appropriate support and training. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The management must 07/06/2010 ensure that staff employed at the home have the skills and competencies to meet the needs of people living at the home. This should include the clinical skills of the registered Nurses This is to ensure that the needs of the people at the home are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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