Inspection on 04/07/07 for West Abbey House

This inspection was carried out on 4th July 2007.

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

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

Other inspections for this house

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 30/01/08

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 Justine Button Unannounced Inspection 4th July 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 West Abbey House DS0000069224.V339519.R03.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.V339519.R03.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 Vacant Care Home 94 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability (0) West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Person of either sex, not less than 60 years, who require general nursing care. Up to ten persons of either sex, in the age range 18-59 years, who require nursing care. Registered for a total of 66 places in categories OP and PD Registered for a total of 28 places in categories DE, MD, DE(E) and MD(E), all in the Lyde Unit. Within the Lyde Unit, no resident shall be under 55 years of age A named RMN, under the supervision of the Registered Manager, will lead the care in the Lyde Unit An additional named individual in the age range 18-59 can be accomodated until such time as a vacancy exists in this age range thus returning the condition to `Up to ten persons of either sex, in the age range 18-59 years, who require general nursing care.` No further admissions can be made in this category whilst this condition is being applied. 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. In a separate wing there is a single storey 28 bedded unit (Lyde) for older people with mental health needs. 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 Lyde unit has it’s own central courtyard garden. Building works are currently being undertaken to improve the enviroment in this area. 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), and are currently developing the services offered to this service user group. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out over one day by two inspectors. The manager Mrs. Bev Davies was on duty on the day of the inspection. The inspectors would like to thank Mrs. Davies and the duty staff for their time and hospitality shown to the inspectors during their visit. The home completed an Annual Quality Assurance Assessment, AQAA, prior to the inspection. A number of service user surveys were sent to the home, of which 10 were completed and returned to the CSCI. Relatives completed several service user surveys. Comment cards about the service from visiting professionals were also forwarded to the CSCI at the time of the inspection. Service users who responded to surveys for the CSCI, all described their ethnicity as white/British. Residents are over 65 years of age bar ten younger adults aged between 18 – 65 years. The inspectors were able to see and observe staff interactions with many residents, meet several relatives, discuss care issues with staff and discuss the management of the home with senior staff. 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. These judgement descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were eight service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the home’s Statement of Purpose, staffing rosters, menus, the home’s complaint’s file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The home completed the AQAA prior to the inspection and forwarded examples of current menus, staffing and rosters. The inspectors also conducted a tour of the premises. The weather was warm on the day of the inspection and the gardens of the home were very well tended. The home is currently undergoing a programme of refurbishment and up grading. This includes the environment for the younger adults and those living on the Lyde unit. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 6 Since the last inspection there has been a change of management at the home. Due to this the home is currently undergoing a transitional period. A number of younger people moved out of the home for the period that the building works were being completed. Some of these people have chosen not to return to West Abbey. This has resulted in some empty beds in this area. The younger adult provision was discussed with the manager. The home is currently considering the care and support that they will be providing in this area. Some of the changes to the environment will then be developed to meet the needs of the service user group. A number of improvements were seen in some areas of the home. The management need to ensure that improvements are consistently applied throughout all areas of the home. For example improvements were seen, on the day of the inspection, in the provision of activities in the lyde area but not for the younger adult living at the home. Choices for people living at the home were available at some periods throughout the day but not at others. The building works on the lyde unit will reduce the number of double bedrooms however the extension will provide a number of new bedrooms. The overall numbers of beds will be increased by two. In addition the manager Mrs Bev Davies needs to complete her application to become registered by the CSCI. Barchester Healthcare need to ensure that they submit the appropriate paperwork to the CSCI registration team in due course. The home’s current fees are £470-580 per week for the older people living at the home. Fees for the younger people are determined upon the assessed needs of an individual What the service does well: The home provides well maintained and pleasant accommodation and grounds. Maintenance records are in good order. Staff recruitment is robust and in line with good practise guidelines. The home was very clean and tidy on the day of inspection. Staff at the home were friendly and approachable. People spoken to confirmed that staff are kind and respectful and inspectors observed staff interacting in a kindly manner with all service users. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 7 Lunch was observed and looked plentiful and appetising having been freshly prepared by the cook. The home has a residents, relatives and supporters committee. This committee is chaired by a relative and meets every month. The purpose of this group is to exchange views and ideas for the improvement of the service. The home has recently increased the number of hours dedicated to providing activities and social opportunities. This area requires continued development. What has improved since the last inspection? What they could do better: Feedback was given to the manager and the homes deputy at the end of the inspection. On the day of the inspection the building work on the Lyde unit was in progress. Whilst the inspectors understand and appreciate the need for this work the noise levels in this area was persistent and excessive at times during the day. Staff need to ensure that when the noise levels are extreme that the impact on the people living in this area is considered. The management should consider using an alternative part of the building in these instances. Staff provide drinks several times a day including early morning, mid morning, afternoon and evening. This is addition to drinks served at meal times. Drinks and fluids were available in all areas, including lounges and bedrooms at other West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 8 times. These fluids in one of the lounges observed were on a table at one end of the room. People sitting in this room were unable to access these drinks. Staff need to ensure that all people have access to fluids at all times. Staff were observed serving the morning drinks in the Lyde lounge. No choice was given to some people living at the home at this time. Staff need to ensure that there is a range of snacks available in all areas of the home. Staff need to ensure that they offer choice when ever possible in a way that is suited to the needs of the individuals and the mealtime experince of those living on the Lyde unit should be further reviewed. The refurbishment where the younger adults reside has been completed. It was disappointing to note that the new kitchen area may not be accessible to people who use wheelchairs. The refurbishment of the Lyde unit is ongoing. The management need to ensure that orientation cues and appropriate and accessible quiet spaces are available. Prior to the inspection concerns had been raised by a relative with regard to staffing numbers and availability particularly in the evenings and weekends. Feedback forms returned to the CSCI confirmed that this was a concern for a number of people living at the home and their relatives. This was discussed with the manager at the inspection. The manager stated that there had been some issues with staff recruitment and obtaining agency staff to cover last minute sickness. The home had recently recruited a number of new staff and it is hoped that this will resolve the staffing issues. It is recommended that the management review the dependency levels of the people living at the home and ensure that sufficient staff are available to meet these needs. It was noted during the inspection that a large percentage of people were being nursed in bed. Staff need to ensure that people living at the home are offered care and support according to their needs. People who are frail may need regular periods of rest on the bed to provide protection of their pressure areas but consideration should be given to the physical benefits, including lowering the risk of chest infections and enabling people to eat and drink more easily when sitting out of bed. A number of people were seen to be sitting in wheelchairs for long periods. Wheelchairs do not provide good postural support. Staff need to ensure that they support people to sit in arm chairs or more suitable seating whenever possible. The care of one individual was discussed with the management at the end of the inspection. The manager agreed to review the care of this person. A number of requirements made at this inspection are outstanding from previous inspections. The management now need to address these issues as a matter of urgency. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 9 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.V339519.R03.S.doc Version 5.2 Page 10 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.V339519.R03.S.doc Version 5.2 Page 11 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): 1, 2, 3, 4, 5. Standard six is not applicable in this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users who move into the home receive a lot of information about the service and have contact with the home to discuss their needs prior to admission. The written information in the statement of purpose is not entirely reflective of current services provided at West Abbey. All service user survey respondents reported that they had a contract with the home. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 12 EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. Copies are made available to service users, prospective service users and their representatives. These documents are also displayed in the reception area of the home and include a copy of the home’s last CSCI inspection report. The information contained in these documents will need to be reviewed to ensure that it reflects the changes to the home. The manager provided the CSCI with pre-inspection information which stated that the home’s current fees are £470-580 per week for the older people living at the home. Fees for the younger people are determined upon the assessed needs of an individual. Any ‘Free Nursing Care’ element awarded is added to the fees and is not refunded to the service user. Extra charges are met by service users for newspapers, hairdressing, trips/outings, personal toiletries/items and special requirements. In addition medical charges may be incurred if applicable for dentist, optician or chiropody. The home’s Statement of Purpose states that four weeks notice is required by either party. The manager or her deputy visit the majority of prospective service user and carry out an assessment to ensure that the assessed needs and aspirations of the individual can be met by the home. The care plan for an individual who had recently moved into the home was viewed this showed that the manager had completed a full pre admission assessment. This assessment was in addition to the assessment undertaken through the care management arrangements. Assessments from other professionals were also seen in care records. Prospective service users and/or their representatives are invited to visit the home prior to making a decision. Service users move to the home initially on a 4 week trial period. This is to ensure that all parties are happy with the placement. This was confirmed by the most recent service user. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 13 West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Care planning systems at the home have improved although further development is required to ensure that clear guidance is given to the care staff. The home has links with other health professionals to enable service user health needs to be met. Personal support is offered in such a way as to maintain the privacy and dignity of service users. Medication is well managed West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 15 EVIDENCE: West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 16 Five care plans were viewed in the main part of the home, these related to two younger adults and three older people. An additional three care plans were viewed for people residing on the Lyde unit. Since the last inspection the home has introduced a new care planning system. This is in line with other Barchester Homes. The care plans viewed had improved from previous inspections. All the plans contained a range of assessments and related care plans. The majority of plans are now more person centred giving regard to the individual’s likes and dislikes. The plans require additional development in some areas. Examples were seen in some that did not give a clear reflection of the person’s needs. For example, in one plan, that was viewed, a risk assessment was in place relating to the risk of falls. This risk assessment did not reflect that the individual had a visual impairment. If this had been reflected in the risk assessment this may have increased the overall risk score and influenced the risk reduction measures and care that staff delivered. This individual had also lost some weight. Investigations were being completed to assess the cause of this weight loss. Due to this a nutritional care plan had been developed although this did not state how further potential weight loss was going to be prevented. The plan stated that the individual did not require staff assistance at meal times. During the inspection it was observed that staff supported the individual with all meals and drinks. This deatil is needed to ensure that the person receives consistent and necessary support from all staff. There was no evidence seen during the inspection that this individual was supported to have “extra” food or snacks between meals or that the calorific value of food had been increased to reduce the risk of possible further weight loss. The plan also stated that the individual could become agitated if exposed to noise. On the day of the inspection building works, which created a high volume of noise, were in progress. No action was taken by staff to prevent the occurrence of agitation seen during the visit. In another care plan which was viewed it stated that the individual had had a recent admission to hospital. The plan did not detail or reflect the action staff needed to take following this admission. This individual had also lost some weight. Although the plan stated that the kitchen had been informed to “enrich all meals” it was evident that the individual concerned did not always eat a full meal at meal times. The plan did not give clear guidance to staff on the action that they should take should this occur. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 17 The care planning arrangements were discussed with the manager during the inspection. The manager stated that she was aware that the plans still had some limitations. Since her arrival the manager had introduced a system for reviewing the care planning process on a regular basis. The “named nurse” now completes care plans. The deputy manager is now reviewing a random selection of care plans on a weekly basis. If issues in the care plan are identified then this is discussed with the individual nurse and the plans rectified. It is envisaged that this system will ensure that plans are completed consistently throughout the home and that improvements continue. Not all service users or their representatives are currently involved in the development or review of the plans of care. This issue has been raised at previous inspections. The involvement of individuals and/or their representative in the plan of care would help towards this communication and ensure that care and support is delivered by staff in the way in which the individual would prefer and take into account the individuals likes and dislikes. In addition the management need to consider how the implication of the Mental Capacity Act will impact on the care planning process. The home has a number of visiting professionals. These include a Physiotherapist and a psychologist, commendable additions to the care team. The physiotherapist currently visits the home once a week for four hours. Although this service is not seen in all care homes the management need to ensure that the time the Physiotherapist has is utilized well. If physiotherapy is to be effective it needs to be completed on a regular basis. The current once a week arrangement does not enable this to happen. Consideration should be given to developing the role of the physiotherapist in to one which develops a physiotherapy care plan, then advises and teaches key staff to complete the exercise with the individual. The physiotherapist could then review the progress made and alter the care plan as required. This would enable staff to be more proactive in physiotherapy and ensure that this is part of the “every day” routine for people living at the home. Access to other healthcare professionals such as Speech and Language is via GP referral as required. All care plans examined demonstrated that people could access to health care professionals including GP, dentist, dietician, CPN, tissue viability nurse and speech and language therapist. A number of service users were monitored over the inspection period by inspectors to observe for regular positional changing and sufficient food and fluid intake in order to meet care needs. The charts used to monitor these aspects of care were observed throughout the day by inspectors and earlier charts examined. The positional charts were completed and positional changes observed. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 18 It was observed during the inspection that in the morning a number of people were sat in the lounge in wheelchairs. Some wheelchairs should be used for transport only as they do not provide good postural support. It is recommended that the practice of people sitting in wheelchairs for long periods is reviewed. The home does provide a range of adequate seating. Service users who were able to express a view were very positive about the care they received. Staff interactions with service users were noted to be very warm, professional and respectful. Interventions were observed to be ‘unhurried’. The majority of staff were heard explaining interventions to service users before carrying them out. Service users appeared relaxed and comfortable throughout the day. Staff were observed to be calling people by their preferred name and appeared aware of their needs. Staff were observed knocking on bedroom and bathroom doors before entering. Service users appeared to be well attired and cared for. This was confirmed by the feedback forms returned by other people living at the home and relatives. Comments included “The management and staff are approachable, easy to talk to and professional” People were observed sitting the communal areas of the home during periods throughout the day. In one lounge it was noted that nobody had access to a nurse call bell and that there were no staff present. A jug of orange squash and a jug of water was seen on a tray with a number of clean glasses. The tray had been placed at the far end of the room. This would not be easily accessible to any individual with mobility problems. Staff need to ensure that fluids are available to all individuals. It was noted during the inspection that a large percentage of people were being nursed in bed. Staff need to ensure that people living at the home are offered care and support according to their needs. People who are frail may need regular periods of rest on the bed to provide protection of their pressure areas but consideration should be given to the physical benefits, including lowering the risk of chest infections and enabling people to eat and drink more easily when sitting out of bed. The home’s procedures for the management and administration of medication was examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). Medicines are administered by the registered nurse on duty. Medicines were found to be securely stored. MAR charts were generally good. Controlled medication was viewed. This was administer and stored in line with correct procedures. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 19 West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The provision of activities is spasmodic although improvements have been seen. People are able to maintain contact with friends and family. The service users’ opportunities to exercise and choice have improved . Meals provided are plentiful and appetising. Service users in the Lyde unit would benefit from more support during meal times. EVIDENCE: The home has increased the number of employed dedicated activity organisers. The manager stated that this has improved the activities programme. Feedback from service user and relatives surveys in this area have been more West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 21 positive than previous inspections. Comments received included “staff do not press me to join in activities which do not please or interest me” “ I commend the recent arrangements for making life histories available to care staff”. On the day of the inspection activities were available to people living on the Lyde unit. These were not always appropriate to the service user group. All staff on the Lyde unit have received training in caring and supporting people with dementia. Following this training staff were observed to be less task orientated and trying to engage with the people living at the home. Some staff appear to have developed these skills more readily than others. Some additional training/mentoring is needed by some of the staff to enable them to put the training they have received into practice. No activities were available for people living in the main part of the home. Documentation seen during the inspection demonstrated that activities are available at times in this area. West Abbey provides care and support for a wide range of people with differing needs and therefore the range of activities available needs to reflect this. The activities for the younger people who live in the home still appear quite limited. The manager stated that this will be developed further once a review has taken place to establish the services the home is going to provide to this service user group. The environmental changes to parts of the building have enabled two kitchen areas to be developed. One in the Lyde unit and one in the area for the younger adults. It is hoped that these will be used to enable people to have more independence and can also be used to develop further activities such as cooking and socialising. On the day of the inspection building work was taking place on the Lyde unit. This meant that there was a large amount of noise for a significant part of the day. In addition to this the television and radio in the lounge were both on at the same time throughout the visit. This led to an environment which was not conducive to the service users particular needs and increased the agitation experinced for some people. The lounge television was on throughout the day with no service user watching this. During the course of the day the programmes ranged from daytime TV to children’s programmes. Staff need to ensure that they support service users to choose programmes appropriate to their likes and dislikes or find an alternative occupation if the TV is not being watched. The Inspectors met four visitors at the time of the inspection. The care team appeared to have developed good relationships with relatives/friends. Visitors spoken to felt welcomed at any time and could spend as long as they wished at the home. Some relatives support their relative at mealtimes. Lunch was observed on the day of the inspection. The meals seen were of a good standard. Specialist diets are provided where needed. Some meals have to be soft or pureed to meet individual needs. People living at the home who West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 22 could give an opinion confirmed this. Some service users sit at the meal tables others have their meals in lounge areas and in their bedroom. Where needed some service users use specially adapted eating and drinking equipment. The kitchen was viewed on the day of the inspection. There was a good standard of hygiene in the kitchen. Drinks are served at regular intervals throughout the day. Biscuits are also offered at this time. A range of snacks were available in the Lyde unit although this was not seen in other parts of the home. This needs to be developed in all areas of the home. The snacks should include foods that are suitable for those people who have problems with swallowing, require high protein intake to aid healing or require high calorific intake to prevention weight loss. These should include supplements prescribed by the GP, milkshakes, yoghurts and fruit. In one area of the home cake was served with the afternoon drinks. No plates or cutlery were available and there was a limited supply of small tables beside chairs to use. For some people this made drinking and eating the cake difficult. Staff were observed supporting some people using their fingers. To ensure good hygiene staff should use a fork or spoon when supporting service users. On the day of the inspection a larger than average number of people were nursed in bed on the upper floor of the main building. Consideration should be given to supporting people to sit in chairs when ever possible at meal times. This will ensure the comfort of the individual and also ensure that swallowing is not compromised. The manager needs to consider the mealtime arrangements for service users on the Lyde unit. This was discussed in detail at the end of the inspection. Not all service users received the support they needed to eat a full meal as staff were engaged in providing meals. Having a member of staff present in the dining room would help to ensure that staff knew that everyone had had a meal before leaving the room. Also about half the service users reamined seated in the lounge for their meal. This appeared to reduce the opportunities for independence for some and others were not in a comfortable position to eat a meal. Systems have now been developed to ensure that choices with regard to meals can now be made more easily. This has included placing menus on the tables in the Lyde unit and staff were observed offering two plates of food at lunch time in order that the person could choose what they wanted. This is good practise for people who may not be able to comprehend verbal choices offered. This however was not seen at all times and in all areas. The management need to ensure that all staff consistently apply improvements and share good practise. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. The home has received a number of complaints since the last inspection mainly regarding care issues, which have generally been upheld. The home management follows adult protection guidance in relation to complaints investigations. The recruitment procedures for new staff are sufficiently robust to ensure that people are protected from the risk of harm or abuse. EVIDENCE: 5 complaints have been received by the home in the last 12 months. One of these was upheld. In addition, the CSCI has received one concern about the service. This concern related to staffing numbers particularly at the weekends and evenings. All people who returned a survey stated that they would know how to complain and would feel comfortable to do so. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 24 Staff records examined confirmed that POVA and CRB checks are obtained prior to an employee starting work. Abuse awareness is included in induction and there has been additional training for staff in abuse awareness since the last inspection. All staff spoken with were clear about the company’s Whistle Blowing procedure. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is safe and well maintained. The home has a range of both internal and external spaces. Some areas require further development. The home now has sufficient accessible bathrooms and toilets The home provides a range of specialist equipment. Fixtures and fittings are of good quality. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 26 EVIDENCE: A tour of the building was conducted over the inspection. The home was purpose built in 1994. The premises have adequate space and equipment to meet the needs of the older adults accommodated at the home. The Lyde unit is secure and has an accessible safe garden. There is wheelchair access throughout the home. The areas meet the collective needs of the service users in a comfortable manner. The home has undergone some environmental changes since the last inspection. The manager’s office has been relocated and there is now a dedicated living area for the younger people at the home. This includes a large lounge/diner. A kitchen area is available in this room. It is disappointing to note, however, that this would not be very accessible for anybody who uses a wheelchair. Only a small part of the work surface is at a lower level and this is of a fixed height. The whole room however is very pleasant and has been decorated and furnished to a high standard. The room has views over the garden. The younger adult accommodation now has both a wet/shower room and a bathroom. This is a marked improvement on previous inspections when people had to go to another part of the home in order to access an appropriate bathroom. Again the new bathroom and wet room have been furnished and equipped to a high standard. A physiotherapy room is also now available. A physiotherapy bed is available but additional specialist equipment is yet to be purchased. The room is relatively small so may become cramped if people living at the home require the use of a hoist. The building works in the Lyde unit was ongoing on the day of the inspection. The changes will include a reduction in the number of shared bedrooms. In addition the staff office is due to be relocated to a room, which will afford more privacy when discussing confidential information. One of the lounges on the Lyde unit has been updated and now contains a small kitchen area. It is advised that before this area is used that the management conduct a risk assessment to ensure the safety of people in this part of the home, whilst providing opportunities for independance. The main lounge and corridors are due to be redecorated and refurbished as the building works progress. The corridors, garden access, bedrooms and communal areas currently lack any suitable orientation cues. This was discussed with the management and it was stated that these will be incorporated as part of the development. The dining room in the main home has been made smaller however this still provides a large airy room which is well presented with all table being set nicely with fresh flowers. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 27 A new hairdressing salon has been incorporated into the building. This area is inviting and appears to be well used. All other areas of the home are well furnished. The standard of cleanliness at the home was good. A strong odour was noted in one area of the Lyde unit. The manager agreed to investigate the cause of this. The home has a range of specialist equipment including adjustable beds, bathrooms and hoists. The corridors are wide and are accessible to people who use wheelchairs. The bedrooms are all single occupancy. All are well furnished. All the bedrooms viewed showed a degree of individuality with personal items and belongings being evident. The gardens are extremely well maintained. The gardens are accessible to people who live at the home. Some raised flower and vegetable beds have been developed. These allow people at the home to complete some gardening. The Lyde unit has it’s own secure garden which is used frequently by people living in this area. During the inspection service users in some areas were observed not to have access to the nurse call bell. It was required that all service users have access to a nurse call bell, unless assessed as being at risk, in their bedrooms. In the previous inspection report the management was advised to consider purchasing some differing call bell lead attachments, which would increase the accessibility to the system for some people. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 28 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. This judgement has been made using available evidence including a visit to this service. Staffing levels may not be appropriate to the numbers and needs of current service users. Staff working at the home have undertaken a range of training in order for them to meet the needs of the people living at the home. The home follows appropriate staff recruitment procedures. EVIDENCE: Copies of a two-week staffing rota were made available to the inspectors. These confirmed that the current staffing levels are adequate given the numbers of people living at the home. The inspector, however, cannot consider the dependency and needs of all the people living at the home during a one day inspection. A concern was received prior to the inspection expressing concerns with regard to staffing levels at times particularly in the evenings and weekends. This was confirmed in three surveys returned to the CSCI. The surveys stated that they did not feel that the home provided adequate staffing West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 29 levels. This was discussed with the manager on the day of the inspection who stated that there had been some issues with recruiting new staff since she had commenced employment at the home. In addition there had been difficulty in acquiring agency staff to cover last minute sickness. Some new staff had recently been recruited and it is hoped that this will resolve the staffing issues. It is required however that the manager review the staff numbers available and compares these numbers to the needs and dependency of the people living at the home to ensure that all peoples needs can be met. The home also employs kitchen staff, domestics, laundry staff and a maintenance person. The registered manager provided the inspectors with information indicating that of the 60 care staff employed, 29 had achieved a minimum of an NVQ level 2 or above in care. An additional 2 staff are undertaking this award. This gives an overall percentage of 50 . Five staff recruitment files were examined. These contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were in place. Staff training files were viewed. Newly appointed staff follow a recognised induction programme. This covers the initial induction programme and ongoing training for staff. All staff have received all mandatory training. Staff spoken with during the inspection were positive about the training opportunities available to them. Staff also indicated that they had received appropriate training to enable them to meet service users’ assessed needs. The staff training file demonstrated that staff have received specialist training in the care and support of people with dementia care needs. This needs to be kept under review as some staff may require additional training/mentoring to ensure that improvements to the care and support offered to people in the Lyde unit is consistently given. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 30 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. Service users and staff benefit from an effective management team who promote an open and inclusive style of management. The financial interests of people living at the home are safeguarded. Staff are appropriately supervised. The health, safety and welfare of people living at the home and staff are safeguarded. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 31 EVIDENCE: Mrs Davies has managed the service for approximately four months. Since this time some improvements have been made at the home. Mrs Davies is a qualified nurse with a range of experiences in management and caring and supporting older people. Mrs Davies has yet to apply to the CSCI to become registered as the manager of the home, but has started the prcess. Staff spoken to during the inspection stated that they felt that Mrs Davies was approachable, that she had an “open door” policy and were positive about the changes. Staff stated that staff morale had improved and that there was now a good team spirit. Since the last inspection a deputy manager has been recruited. This has given Mrs Davies support to implement improvements at the home. The home has a quality assurance system. The home has a residents, relatives and supporters committee. This committee is chaired by a relative and meets every month. The purpose of this group is to exchange views and ideas for the improvement of the service. In addition a range of staff meeting s are held on a regular basis. All these meeting have documented minutes. Staff stated that they receive regular supervision. Supervision is the opportunity for the staff member and the management to meet and discuss aspects of care practice; philosophy of the home and career development needs. Accident and incident forms were viewed during the inspection. These demonstrated that staff took appropriate action following any accident. The management of service users personal monies was discussed with the administrator. 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. All records seen at this inspection were stored in accordance with the Data Protection Act 1998. The home’s procedures for ensuring the health and safety of service users, staff and visitors were examined and a tour of the premises was carried out. All were in good order. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 32 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 33 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 OP7 Regulatio n 15 (2) Requirement It is required that the service user plans are reviewed to ensure • That the plans adequately reflect the current care needs of the individual and provide clear guidance to staff. • Service users and/or their representatives are involved in the development and review of the plan. Timescale for action 19/09/07 This requirement is outstanding from the last inspection. Previous timescale 30/04/06 & 27/07/06 2 OP8 12 (1) (a) It is required that all people have access to fluids throughout all periods of the day. This requirement is outstanding from the last inspection. Previous timescale 15/03/06 & 06/07/06. 19/09/07 West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 34 3 OP15 16(2)(i) The manager must review the mealtime arrangements for service users on the Lyde unit to ensure that all are supported to have adequate quantities of food and fluid at mealtimes, suited to their needs. It is required that all service users have access to a nurse call bell, unless assessed as being at risk, in their bedrooms and communal areas. This requirement is outstanding from the last inspection. Previous timescale of the 15/03/06 not met. 10/08/07 4 OP22 12 (1) (a) & (b). 12 (3). 13 (6). 19/09/07 5 OP27 18 (1) 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. 19/09/07 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. 2. 3. Refer to Standard OP8 OP8 OP8 Good Practice Recommendations It is recommended that people are supported to access suitable seating. It is recommended that the role of the physiotherapist is reviewed to ensure effective use of the time available. It is recommended that the time people spend is bed is reviewed to ensure care and support is delivered in line with their assessed needs. DS0000069224.V339519.R03.S.doc Version 5.2 Page 35 West Abbey House 4. 5. 6. 7. OP8 OP15 OP15 OP12 It is recommended that people are supported to access suitable seating which provides good postural support and does not compromise pressure area care. It is recommended that the availability of appropriate snacks be extended to all areas of the home and to all service user groups. It is recommended that when staff support people with eating and drinking appropriate cutlery is used. It is recommended that the provision of activities on the Lyde unit is reviewed to ensure that they are appropriate and meaningful to people with dementia care needs. This may involve supporting staff to implement the training they have received. West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Taunton Local Office 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 West Abbey House DS0000069224.V339519.R03.S.doc Version 5.2 Page 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!