Inspection on 30/01/08 for West Abbey House

This inspection was carried out on 30th January 2008.

CSCI found this care home to be providing an Good service.

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

West Abbey House 01/04/10

West Abbey House 21/01/10

West Abbey House 19/11/09

West Abbey House 05/08/09

West Abbey House 04/07/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE West Abbey House Stourton Way Yeovil Somerset BA21 3UA Lead Inspector Barbara Ludlow Unannounced Inspection 30th January 2008 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 West Abbey House DS0000069224.V358271.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. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Abbey House Address Stourton Way Yeovil Somerset BA21 3UA 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) 01935 411136 01935 420829 westabbey@barchester.net Barchester Healthcare Homes Ltd Mrs Beverley Francis Davies Care Home 97 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (55), Physical disability (10) of places West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 The maximum number of service users who can be accommodated is 97. 4th July 2007 2. Date of last inspection Brief Description of the Service: 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 it’s own central courtyard garden. The home’s current fees are £550 per week plus free nursing care, for younger people fees are in line with their individual care needs assessment. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during 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 for the seven chapter outcome groups and an overall quality rating is then calculated: : The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection was carried out over two days by two inspectors and an expert by experience from Help the Aged. A tour of the premises was made over the two days and time was spent in each area of the home. People who live at West Abbey were seen and visiting families and friends were spoken with and asked for their views about all aspects of the care and service offered. The manager who was away on a training course on day one returned to the home to assist with the inspection process. The deputy manager and the homes staff team were approachable and helpful throughout the two day period. Records required for inspection were available. These included care plans, recruitment and training records, medication management records and maintenance schedules. The expert by experience observed daily life and spent time meeting people, seeking their opinions and views on the care service. Very positive feedback was heard. Feedback was given by the expert and the inspectors to the manager and her deputy on day one and on the conclusion of day two. What the service does well: West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 6 The service delivers nursing care to a good standard in this large care home that caters for older people, a smaller number of younger adults and there is a specialist dementia care unit. There is a good level of management supervision and positive action is taken to ensure high standards of care are maintained. The home has a broad and skill mixed staff team including domestic, reception and administration, maintenance and catering staff to manage all aspects of service delivery. Staff are inducted into their roles, they receive training and supervision and have opportunities to increase their knowledge and skills to deliver a good standard of care. The home is purpose built and is well maintained. The home is welcoming and a comfortable place for people to live and to visit. The administration of medication was safely managed. Catering is well managed, nutritious food and special diets are well catered for. There are good opportunities for people to join in with activities and social events. What has improved since the last inspection? What they could do better: Drinks must be accessible for those who are in resting and are nursed in bed to ensure they can both reach and receive sufficient amounts of fluids to drink. Nurse call bell use must be reviewed to ensure that people can access their call bell to summon help if and when they wish. Those who cannot use a nurse call bell must have care planned that includes regular checks and record keeping for this care intervention. Staff recruitment was examined and gaps in employment history were seen where this had not been explored at interview. This must be addressed to ensure the safety of people living at the home. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 7 Two people were seen who would benefit from special seating. One person had suffered a bruised eye following a recent fall. They were seen to be slowly sliding from an unsuitable chair and they had to be eased back by staff who were on hand and who were watchful and extra vigilant to the persons needs. The manager was alerted to this and she identified a solution to this and the seating was to be addressed after the inspection. Care must be taken to identify any such special needs and then address them promptly for the safety and well being of the person. It was a particularly windy day and the double patio doors in the Lyde unit were allowing very cold draughts to blow into the lounge area. Two people complained to the inspector that they felt cold; they were seated in the area close to the double doors. This was brought to the attention of the staff and the maintenance staff at the inspection. Staff raised concerns about the numbers of staff allocated onto the Lyde unit saying at times the unit is very busy and the minimum staffing is not enough. Care must be taken to have sufficient staff in number to adequately meet the dependency needs of people and allow for the extra staffing where needs have been identified and funds have been allocated for 1:1 time. 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. West Abbey House DS0000069224.V358271.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 West Abbey House DS0000069224.V358271.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): 2,3,6 is N/A Quality in this outcome area is good. Pre admission assessments are made to assess that care needs can be met at West Abbey before an admission to the home is accepted. This judgement has been made using available evidence including a visit to this service. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 10 EVIDENCE: Care plans were sampled including one recent admission to the home. The homes manager had undertaken a pre admission assessment. Details were taken from the hospital about the person’s health and well being and risks to their health. The community single assessment document (SAP) had been received at the home to inform the pre admission assessment. Identified risks had been assessed and the care planning detailed measures to monitor and reduce these risks. The commission had received a copy of the homes pack ‘Resident’s terms and conditions’, a Barchester company wide document that is very detailed. There is a ‘Residents admission agreement’ in this which gives a clear indication of admission service detail, costs, method of payment and is signed as an agreement either by the resident or other person responsible for the payment of fees, when the place is accepted. One relative spoken with confirmed having visited the home to look around before making this their choice. Contracts were sampled, one identified a pre admission assessment, it was not clear that this person who was funded by a county council had received terms and conditions of residency. One other had the ‘resident’s admission agreement’ with the breakdown of the funding and payment arrangements. West Abbey House DS0000069224.V358271.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): 7,8,9,10,11 Quality in this outcome area is good. Care plans were in place and demonstrated attention to all health and social care needs. Medication management and administration was safe. People asked confirmed our observation that they are treated respectfully. Terminal and palliative care is delivered with care and sensitivity. This judgement has been made using available evidence including a visit to this service. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 12 EVIDENCE: Daily life at the home was observed over the two day period by the inspectors from CSCI. The ‘Expert by Experience’ assisting with the inspection spent time meeting and speaking to people in residence and their relatives and friends and observing daily life, on day one. Care plans were sampled and the daily routines for care giving were observed over the two day inspection period. Care plans on the first floor of the home were seen to be stored on top of the open plan nurses station. This was raised as a data protection issue on day one an immediate requirement was made for safe storage. This was addressed immediately and was in use on day two. Seven care plans were chosen for case tracking. These evidenced a good level of assessed need and risk assessment covering communication, personal care, skin integrity, anxiety, nutritional profile, moving and handling, religious belief, social skills, weight monitoring, pressure sore risk assessment (Waterlow), wound care and specific disease management such as diabetes. People were asked about their personal preferences regarding the gender of staff delivering their personal care and this was recorded. This also formed part of the care plan review. People asked confirmed that they were happy with the care they received. Care plans also paid attention to personal appearance and preferences. Health promoting referrals were documented for flu vaccination and cholesterol level monitoring. Risk with regard to falls was recorded and body maps were in place to note injury such as bruising. Instructions to staff were clear and detailed. Records of visiting health care professionals were recorded and specific instructions such as those regarding changes to medication were recorded. One file seen did not have a completed life history and there was little mention of 1:1 activity for this person. On day one 51 people were in residence in the general nursing part of the home and 30 people were living in the Lyde Dementia care unit. A tour was made of the premises. On ‘Preston’, nine younger people were in residence. Twelve older people were in residence on this floor. At 10:25am the inspectors found that all people on this unit were still in bed. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 13 At 10:30am one person from the older person unit wings ‘Newton and Hendford’ on the ground floor was up and was sitting in the lounge, they had fallen asleep. Bedrooms were therefore sampled later in the morning, when fifteen people remained in bed. Staff said they where there either by choice, current illness or because of the frailty of their condition. People had adjustable beds and pressure relieving equipment in use where required. Six of eight people seen did not have access to a drink. Nine people did not have access to a call bell. Two people were identified by staff as being unable to use their bell, they were described as having regular two hourly checks made by the staff. There was no mechanism in place to record and to confirm these checks having been made. Staff seemed to be running late with the daily care on day one. People were still being helped with their personal care at lunchtime. Day two was different and staff had assisted those requiring personal care and assistance well before lunchtime. Staff were observed to speak and interact with people in a friendly and polite manner. One relative and one service user commented on how busy staff can be. They had experienced waiting for the bell to be answered and quoted one occasion where their relative was left in a soiled state until staff were free to help. The inspector heard that communication with staff could also be problematic where the staff do not speak English as their first language. The charts for people in bed who are frequently repositioned and have their fluid intake recorded were in use and were up to date. Where oxygen had been in use there was oxygen signage but there was no indication of the hazard, this should be addressed and the signage updated. The home has a nurse leading palliative care and is introducing the end of life care pathway system. For palliative care pain control, specialist equipment such as syringe drivers are accessed from the community ‘STAR’ team and trained nursing staff use them. Other specialist equipment included suction equipment and a nebuliser, these are maintained in house and are subject to PAT testing (See NMS 38 maintenance). Feeding pumps and equipment are maintained externally. The homes physiotherapist has a dedicated and equipped physiotherapy room on the ground floor. The physiotherapist visited West Abbey on day one of the inspection. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 14 The home has also arranged access to a clinical psychologist where required for people in residence with challenging behaviour and their families. Medications management was inspected on the general Unit and the Lyde unit. The medication storage areas are temperature controlled with air conditioning units and are temperature monitored on a daily basis. The recorded readings were all satisfactory being below 25 degrees Celsius. Medication Administration Records (MAR charts) were examined, two signatures were seen where drugs had been received into the home. There was photographic identification and special instructions were recorded for each person. Variable doses were colour co-ordinated on the MAR chart. Blood sugar monitoring was recorded for people with diabetes. Capillary blood sampling and phlebotomy equipment was available and appropriate for a safe system of working and was all in date. The medications fridge temperature was seen to be within safe limits reading 5-7 (safe range 2 to 8) degrees Celsius. Controlled medication was checked. This was found to be stored correctly and the quantities were correctly recorded and tallied. Controlled drug storage and record keeping is checked at each staff shift changeover. The records for the checks was seen and with one exception they were up to date and satisfactory. Four local GP practices have signed up to the homely remedies policy for the people in residence, one GP practice has refused to do so. Evidence of the homely remedies was held with the MAR charts. One person having creams ‘as required’ did not have any entries for administration nor any mention of the prescribed creams in their care plan. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 15 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 good. People can spend their time as they choose. There are activities available for people who wish to join in. Families and friends visit and are made welcome. Mealtimes were observed as a varied experience but the food served was well presented and appetising. The catering staff are knowledgeable about special dietary provision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On day one of the inspection the visiting ‘expert by experience’ spent time with the people who live at the home and the following observations were made: All the people spoken with confirmed that there were activities available if they chose to join in. In discussion with the activities assistant and seeing the programme a number of group activities are available e.g. crafts, art, quizzes, bingo etc. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 16 People are encouraged to go from one unit to another to participate in these activities. However given the number of residents that stay in bed the two activities assistants do spend time with each resident on an individual basis two or three times a week reading, giving hand massage, taking a poem and associated articles to feel and touch etc. Records are kept showing which activity is done with each person and their likes and dislikes are noted’. Positive feedback was heard from people living at West Abbey. One person said the ‘food was excellent’ and they are ‘very pleased’ the ‘care is good’. The expert by experience reported that ‘Staff seemed to use residents preferred names and people confirmed that staff always knocked on their doors, and maintained privacy in personal care tasks. One relative said they ‘couldn’t speak more highly’ of the care home. They are pleased with communication with the G.P and are ‘kept in touch’, and ‘excellent’. People visiting confirmed that they are made welcome and can come in as often as they wish. The manager holds meetings for residents and their families. One visitor commented that they have become involved in a relatives support group. There is a relative run gardening club that is held on a Sunday, once per month. It was reported that six families came to the Lyde unit at Christmas. Visitors also confirmed that they are able to have meals at the home. Lunchtime was observed in the dining rooms by the inspectors and the expert by experience. People were seen in the dining rooms, those who required assistance were helped in a supportive and discreet manner. The expert by experience observed that: ‘a member of the kitchen staff went out with the food trolleys and they observed that she actually served the food on the Lyde unit. Care staff showed the people living on this unit two plates with both choices on offer so that people could indicate non-verbally what they wanted if they were unable to verbalise their choice’. Also noted was that the process of offering the choices, getting the meal served, and then cutting up the food left a number of residents sitting with no food whilst some people had already finished and were leaving the tables. It was felt that this may have been due to some of the staff being busy elsewhere at lunchtime. Menus served during the inspection were varied and nutritious. Special diets are catered for, these included gluten free, low fat and high protein. Soft diets are pureed separately. Special aids such as plate guards to assist independent eating were seen being used at lunchtime. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 17 The chef was seen and spoken with, we were informed that the kitchen and catering had received favourable high marks at the last the environmental heath inspection. Alternative meals are available and the chef said he was able to buy food to meet an individual’s request. The expert by experience noted that ‘The chef organises special meals to celebrate occasions e.g. Burns night, Valentines Day, and the activities assistants arrange to decorate the dining room appropriately’. We heard that snacks are available from the kitchen via the hotel service and that fruit bowls are prepared for each floor. The fruit bowl was seen on the Lyde unit where people were seen to help themselves. Drinks were available in the dining areas and communal rooms. Not all people in their rooms had access to a drink at all times during the day. Activities on day two were held in the main general dining room. People were seen making Valentines cards, they were having fun and were laughing together. Main activities are held in this room where there is a piano, which had been recently tuned. The expert by experience noted that ‘Residents are taken out on trips, but the mini-bus can only take one person in a wheel chair and three others, so many people don’t get out’. And also that ‘Residents on the Lyde unit have their activities organised by two care staff, one of whom was doing some painting with a group of six people. They said that the visiting musicians come up to the Lyde unit as well as entertaining on the Nursing wing, and residents are taken from the Lyde unit to join in activities in the other units. Communion is offered once a week by a member of a local church. Staff with hairdressing qualifications do peoples hair in the dedicated salon. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 18 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): 16,18 Quality in this outcome area is good. The home has a complaints policy and procedure. Robust management enquiry and action is taken when a concern is raised. Recruitment systems used will help protect people who use the service from harm. People can access an independent advocate and are registered to vote. This judgement has been made using available evidence including a visit to this service. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home has a complaints procedure. There is the facility of accessing an independent advocate. One complaint had been raised at the home and was discussed at the inspection. This had been resolved; support had been identified and successfully given as a positive consequence of this matter being raised with the manager. A further concern had been raised about a care event, evidence of robust enquiry and action being taken was seen. Staff recruitment was examined in detail. There was evidence of sound recruitment practice. References are taken up. Staff have Criminal Record Bureau (CRB) checks with a preliminary minimum Protection of Vulnerable Adults (POVA) list checking before they commence working at the home. People living at the home and their visitors were consulted about complaints and very positive feedback was heard. Visitors said they feel able to raise any concerns with the manager and staff at the home. People asked confirmed that they have been added to the local electoral register to be entitled to vote in local elections. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 20 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): 19.26 Quality in this outcome area is good. The home is clean, very well maintained and was purpose built. There are good infection control measures in place. The home has separate catering, cleaning, care and nurse staffing. This judgement has been made using available evidence including a visit to this service. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 21 EVIDENCE: The tour of the premises found the home in good condition. The premises were purpose built and have wide corridors and a 13 person passenger lift giving good wheelchair access around the building. The communal rooms are comfortable and have good natural light. The individual accommodation older and newly built is well appointed, comfortably furnished and can be personalised. There is a good level of equipment with adjustable beds and specialist equipment for pressure relief and nursing care. Fifteen people were identified that were staying in bed for various reasons, nine people did not have access to a nurse call bell. Nurse call bell leads were not in place in two rooms where people were nursed in bed. The and and and dementia care unit is appropriately decorated to aid people’s independence interest around the unit. There is use of colour coordination for the toilets there are objects of reminiscence around the corridors for people to view handle. Where individuals have been identified to require specialist seating to keep them comfortable and safe this should be accessed more promptly. Two people were identified that were said by staff to require more specialised seating to seat them comfortably and safely. One of these people had recently fallen from their chair and had suffered a bruise to their face. This person was receiving extra monitoring and regular attention to their seated position to maintain their comfort and safety. Staff asked said they had requested and applied for specialist community health input for seating and had been unsuccessful. The registered manager was asked about this situation and two chairs were identified at the inspection for use without further delay. There are infection control measures in place. All staff have access to personal protective clothing and there are sufficient hand washing facilities for them around the home. There are separate staff for catering, cleaning and nursing / care duties. The home has sluice facilities and sufficient toilets and bathrooms. One bedroom had a strong malodour, which should be remedied, sufficient carpet cleansing or replacement is recommended. One bathroom was seen that was being used as a storage space for equipment. This room was to be de-cluttered at the end of day one of the inspection. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 22 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 adequate. The home has a large skill mixed staff group. Staff receive induction, mandatory and ongoing training to deliver care to a good standard. Recruitment and interview evidence gathering and record keeping could be improved. There were sufficient staff seen on duty but there is a risk to individual care when needs are high and the minimum assessed staffing level is not met. This judgement has been made using available evidence including a visit to this service. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home has a skill mixed team that is led departmentally by senior / heads of department. There are separate nursing, care and activities staff, housekeeping, domestic and laundry, catering and kitchen hotel services, maintenance, gardening, reception and administration. The home has recently appointed a staff trainer. There was a sufficient number of staff on duty at this inspection. On the Lyde unit there was a high demand on staff time due to the need for dedicated one to one time. The scheduling for this extra time allocation was not clearly apparent within the staff team observed at this inspection. People commented that staff are always busy. They also said that at times there are not enough staff to attend to their needs when they call. Examples were given by relatives and people living at the home where they were asked to wait for attention. There were a high number of people receiving care in bed and people with higher dependency care needs. This may be having an adverse impact upon staff response times. Staff rotas were examined and an adequate staffing ratio is planned but was not always maintained. Agency staff are used to cover shortfalls, the manager when asked stated that this equated to one to three shifts per week with the agencies used trying to send regular staff. The personal care giving in the morning of the first day was running late and people were receiving care when others were ready for lunch. The situation was better on the second day and staff managed their busy morning well. The staffing level must be kept under constant management review to ensure that care needs can be met in a timely manner that is not detrimental to the peoples experience of living at the home or their well being. Staff recruitment was analysed for seven new starters since the last key inspection. The home has a new administrator and time was taken to explain the requirements and responsibilities for the management of safe recruitment administration processes. Two files had no photographic identification; three had incomplete employment histories and no explanation for gaps in employment history being explored before or at interview. Protection of Vulnerable adult list checks were dated after the persons start date this was an error and the actual start dates were examined against payroll and were found to be satisfactory. These findings were brought to the managers attention, a new camera had been purchased that could be used to take the staff photographs. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 24 Care must be taken to ensure recruitment processing is more strictly recorded to reduce the risk of someone commencing work at the home without the full and proper checks being undertaken and verified as satisfactory by the manager. The home has a dedicated staff trainer. The inspectors were able to spend time hearing about the training achievements made and were pleased that staff training has improved. There was good evidence of staff receiving induction in line with Skills for Care and mandatory training for manual handling, fire and the protection of vulnerable adults. Staff have been encouraged to undertake National Vocational Qualification (NVQ) training and have been supported in achieving this. The home has achieved the over the minimum of 50 of care staff achieving NVQ Level 2 or above. Records were inspected for fire training and with one exception all had been carried out. Staff spoken with during the inspection confirmed having received health and safety training with, where appropriate, information about COSHH. Other staff confirmed having manual handling training and updating. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,38 Quality in this outcome area is good. The home is managed in an open and approachable style, which is effective and benefits the people in residence and their families. Individual finances are safely managed. Staff supervision should be improved. The home is well and safely maintained. This judgement has been made using available evidence including a visit to this service. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mrs Davies is an experienced nurse manager and has been approved as the registered manager for West Abbey by the CSCI Fit Person process, since the last inspection. The home has a capable deputy manager who gave her assistance to the inspection process at the start of day one. There has been progress made at the home with care planning. The storage of care plans on the first floor of the general wing was inadequate and did not offer safe storage of individual care plans, as they were seen piled onto the desk area of the nurses station. An immediate requirement was made and was to be adhered to by the close of day one. The action taken to safeguard these records was confirmed on day two. The home has a quality assurance system where the company carry out customer satisfaction surveys; this was last done in October 2007. There has been a residents and relatives meeting with the registered manager. The inspector heard that there is an active committee chaired by a relative, which meets every month. The purpose of this group is to exchange views and ideas for the improvement of the service. A gardening group has started up which meets on one Sunday in each month. Staff and departments meet, all meeting are have minutes recorded. Staff supervision is ongoing but was not yet comprehensively organised, a matrix is recommended for monitoring this. Personal finances were checked in line with people that were case tracked at the inspection. There was also discussion with the manager and deputy manager about the system for storing and recording any money held in safekeeping for an individual. At the last key inspection it was reported that Cheques are paid into a personal monies account. Costs such as hairdressing and private chiropody are invoiced on a monthly basis. The costs are then deducted from this account. Some petty cash is held at the home for any person who requires cash or money for other expenses. A statement is given on a monthly basis to individuals detailing the balance of their account. All accounts are non-interest bearing. These systems were unchanged at this inspection. The records for maintenance of the home were examined. The home has two dedicated maintenance staff and selected records were made available for inspection. These included: Fire safety, a fire evacuation and drill (for staff) were last carried out 2/1/08. Fire extinguishers were serviced in July 2007. Emergency lighting was checked in 12/07 and the fire alarm was checked on 28/01/08, all zones are tested in rotation. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 27 Hoist and lift servicing, was dated 31/10/07 Electric beds were checked in December 2007. Portable Appliance testing was seen for various recent dates. Nursing equipment that falls under this testing must be identified and checked periodically. Gas safety inspection was made on 26.06.07 Nurse call, 2.08.06 with follow on monthly in house checks and repairs seen for 2007. There is regular testing for hot water temperatures and unused outlets are safely maintained. A detailed and extensive list of environmental checks is made each month by the homes maintenance team. Accident records are audited and are recorded in line with Data Protection Act. Oxygen cylinders were seen that were stored insecurely. They pose a risk of hazard should they topple over, either from becoming damaged and leaking or by causing injury if they fell onto someone. An immediate requirement was issued on day one. This was confirmed as completed on day two of the inspection. Signage for oxygen when in use should have hazard warnings to alert people to the dangers oxygen use can pose, this is recommended as a result of this inspection. West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 X 18 3 3 X X 1 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 2 West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP8 Regulation 16(2)(i) (4) Requirement Fluids must be available to those who can manage independently at all times when sitting in their rooms or when in bed. Call bells must be accessible at all times and must be placed within reach after care interventions / changes of position. A recorded system of appropriate supervision is required to be implemented to support people to summon assistance when needed. Call bells must be available for use in each bedroom. Designated storage must be used rather than communal bathrooms for equipment that is not in use. It is required that the manager reviews the numbers of staff available to ensure that the needs of the people living at the home are met. DS0000069224.V358271.R01.S.doc Timescale for action 21/04/08 12(4)(a) (b) 17(1)(a) Sch.3 (l) 2. 3. OP22 OP22 23(2)(c) 23(2)(l) 21/04/08 21/04/08 4. OP27 18 (1) 21/04/08 West Abbey House Version 5.2 Page 30 5. OP29 18(1)(a) Previously required by 19/9/07 Recruitment procedure must include that at interview any gaps in employment history be explored and the reasons for them be documented, to ensure the safety of people using the service. 21/04/08 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 OP8 OP26 OP38 Good Practice Recommendations It is recommended that people are supported to access suitable seating, which provides good postural support and does not compromise pressure area care. Where carpet has become malodorous it should receive sufficient cleansing or be replaced. Nursing equipment that is electrical and not subjected to a recognised servicing contract should be included on the home maintenance testing for the safety of portable electrical items (PAT). Signage for oxygen when in use should have hazard warnings to alert people to the dangers oxygen use can pose. Denture cleansing tablet storage in en suite facilities should be risk assessed for the individual choosing to use them. Alternative safe storage arrangements should be made if there is any risk of the person or other person with access, accidentally ingesting the tablets. 4 5 OP38 OP38 West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 West Abbey House DS0000069224.V358271.R01.S.doc Version 5.2 Page 32 - 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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