Care Home: Abbas Combe Nursing Home

What the care home does well Information is available to people who wish to use the service. Care needs are assessed prior to admission. People enjoy an excellent standard of food in the home. There is a complaints procedure in place. There are robust recruitment procedures in place. There is a staff training programme in place. Quality assurance is addressed in the home. What has improved since the last inspection? The redecoration programme has continued and there are new carpets, furniture and curtains. Activities have been further developed and links have been made with a local nursery school. What the care home could do better: There has been a lapse in the recording of water temperatures which the home agreed to address. Key inspection report Care homes for older people Name: Address: Abbas Combe Nursing Home 94 Whyke Road Chichester West Sussex PO19 8JF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Abbas Combe Nursing Home 94 Whyke Road Chichester West Sussex PO19 8JF 01243789826 01243775111 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lotus Care 1 Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 25. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Abbas Combe is a care home with nursing situated on the A27 ring road to the south of Chichester and is approximately a twenty minutes walk to the town center with all its amenities. The home was originally a detached house, which has been altered and extended to provide accommodation for twenty-five people in the category Older Persons. The accommodation is offered on two floors, with passenger lift access to the first floor. Accomodation is offered in mainly single rooms but also has two shared Care Homes for Older People Page 4 of 24 Over 65 25 0 Brief description of the care home rooms, many with en-suite facilities. There is a choice of communal day space including a sitting room and conservatory/dining room. The home is surrounded by attractive gardens, and a limited amount of parking space is available. The fees charged are £600-£730 Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection process was carried out on 29/09/09. It was undertaken by a lead inspector from the Care Quality Commission and was facilitated by the new manager, the deputy manager and the Lotus Care Group manager. Staff and people who use the service were involved in the inspection process. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home and any documents required on the day were made available. We were in receipt of eight surveys from people who use the service, four from staff and one from a professional. All expressed satisfaction with all aspects of the home. People who use the service, one visitor and staff were spoken with on the day and surveys undertaken by the home were available. People who use the service spoken with stated that they are happy in the home and that they enjoy the food. All appeared happy were well dressed and the atmosphere in the home was relaxed. There is a varied activities programme in the Care Homes for Older People Page 6 of 24 home and people expressed satisfaction with the activities on offer. Staff spoken with on the day stated that they were happy working in the home and that the management was supportive. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to use the service have their needs fully assessed prior to admission. Evidence: People who use the service are fully assessed prior to admission to the home. All medical , nursing and personal care need is assessed and recorded. This includes mental health, continence, mobility, and communication. Three people who use the service the service were case tracked and evidence of assessment was present in the care plans. The AQAA stated that the home continues to meet this standard on preadmission assessment. An up to date statement of purpose and service user guide is available which includes details on the assessment of people under the Mental Capacity Act to ensure roles of all involved are clear so that the best interests of people who use the service are served. The home has a website so people can access informationon the home via the internet. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs assessed, recorded and met. Evidence: All residents had a plan of care. Three people who use the service were case tracked. The care plans inspected contained information on health, nursing, personal and social need. The care plans were drawn up following an assessment of these needs. This included nutritional assessments, mobility, hygiene, continence, and pressure areas, and risk assessments. The risk assessments covered falls, nutrition, choking, wandering, skin assessment, nursing and personal care needs such as the number of carers to move the person or the use of a slide sheet required. A malnutrition screening tool is in use and peoples vulnerability is assessed. The care plans were up to date and had evidence of monthly review. Weight is monitored. Access to specialist health support is available as required including general practitioner, chiropodists, and outpatient appointments. There is a domiciliary dental and optician service. The home accesses the services of the community Nursing team. Comments received from a community nurse in January were positive Abbas Combe Care Homes for Older People Page 11 of 24 Evidence: is a well run home, I have always felt that staff are helpful and consistent when I visit. Subsequently the community nursing team raised concerns about wound care in the home. There has been a safeguarding adults investigation regarding the wound care offered to one person who is no longer accommodated in the home. The wound care for two people accommodated in the home at present is up to date. West Sussex adult services are to be more specific about care plans they require before placing people in the home. The home has fully cooperated with this process, has put in place wound care training and is providing West Sussex with a strategy plan. The manager employed in the home at the time of the alert is no longer employed in the home. Staff were observed offering care in a respectful and encouraging manner and people who use the service spoken to stated that they are treated with respect. People who use the service and relatives spoken to stated that care is offered as assessed. Medicines are received, stored, administered and recorded appropriately. Most medicine administration charts inspected were up to date although one had been signed on the morning of the visit but the drug had not been administered as it was still on her bed table. This was rectified. The deputy manager had arranged for the pharmacist to visit to discuss medication issues and a training day is to be offered to staff. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle in the home meets the needs of people who use theservice, participation is encouraged and people receive a fresh, appealing and nutritional diet. Evidence: The home has developed further the activities on offer since the last inspection. The service user guide lists aromatherapy, hand and foot massage, beauty sessions, manicures, movement to music, bingo, quizzes, themed days and meals, trips out and entertainers throughout the year. One staff member has one hour each day to devote to activities and another attends once a week to do crafts and planting seeds. A production company attends three times a year at Easter, once in the summer and at Christmas to put on a show. Children from a local nursery are invited to sing carols at Christmas. The home has just had a summer fete and a singer a performed at this. An entry was seen in the diary for one person who requested to watch a movie. Activities records are kept and attendance and refusal is recorded. A visitor spoken with confirmed that visiting is welcomed. personal choice is Care Homes for Older People Page 13 of 24 Evidence: encouraged as is involvment in the activities of the home. People are encouraged to use the sitting and dining room. The new manager stated that she is considering introducing a newsletter to help communicate with people who use the service and relatives. The chef was spoken to and there is a six week menu in place. The chef has a budget and is responsible for ordering the foods required. Fresh seasonal vegetables were being used. All people who use the service and one relative spoken with expressed satisfaction with the food offered. The relative stated that he is given lunch every day when he visits. There is always choice available. People are asked on a daily basis what their choice of food is for the following day. Eight surveys were received from people who use the service and seven were positive in all areas. One commented Our cook is excellent. The meal seen prepared and served on the visit was nutritious, very well presented and people stated that they enjoyed it. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are listened to and training ,policies and procedures are in place to protect people who use the service. Evidence: There is a clear and accessible complaints procedure in place and people who use the service and a relative spoken with stated that they were aware of, although all stated that they did not have reason to complain. There is the facility to record any complaints including actions and outcomes. Postal votes are arranged for people who use the service and there are details of advocacy services in the home, this is referred to in the Service User Guide and details are in a folder in the hall. There has been a recent safeguarding adults investigation, raised in April of this year, which the home fully cooperated with. There are policies and procedures in place regarding safeguarding adults and whistle blowing. All staff have been given The West Sussex Safeguarding Adults Procedures and the Say No To Abuse document. All staff had Safeguarding Adults training in May and June of this year. Staff spoken to were clear about the procedures to follow in Safeguarding Adults Allegations. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable and well maintained environment Evidence: The home continues to maintain and decorate the communal areas and bedrooms with new carpeting, furniture and curtains evident. Bedrooms were neat clean and personalised. Bedrooms are decorated as they become vacant. There are pleasant, well-decorated communal areas; a sitting room and a conservatory/dining room. People who use the service spoken with expressed satisfaction with the accommodation on offer. One person stated It is very comfortable here One visitor spoken with who has spent some time in the home on respite care in the past said it is a lovely home. The home was neat, clean and free from offensive odours throughout. The home has a passenger lift, grab rails throughout and the required hoisting and pressure relieving equipment. Nursing beds are available for those people assessed as needing them There are suitable bathroom, toilet and laundry facilities. There was evidence that bath temperatures are tested in one bathroom but not in another. The new manager stated that this would be put in place. The group manger stated that an external company has recently been contracted to complete a water survey, this is to prevent Care Homes for Older People Page 16 of 24 Evidence: the spread of Legionella. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are met by a suitably qualified and trained staff. Evidence: The staff rota show sufficient staff on duty to meet the care needs of people who use the service. There is a new manager and deputy manager in post. Staff spoken with confirmed that that this was supportive place to work. People who use the service spoken to stated they were happy with the number of staff at the home and found them to be kind and knowledgeable. One person who uses the service stated The staff are very kind. All confirmed that they were well cared for. Seven out of eight surveys received from people who use the service were positive about staffing issues. A relative stated they do everything for her, she relies on them and they turn her every two hours Surveys received from staff were very positive stating the home was a supportive place to work. Evidence of training was seen on a matrix and in staff files. Induction and mandatory training is carried out and is up to date. All staff received safeguarding adults training in May and June. First Aid is planned in September, moving and handling in October and infection control in November. The AQAA states all catering ans care staff have Care Homes for Older People Page 18 of 24 Evidence: had food hygiene training. The new manager and deputy manager are planned to attend a tissue viability course and an in house wound care training session for all staff is to be arranged. The local pharmacy who visited in the day of the inspection are to do a training session on medicines. The AQAA states that four of the sixteen care staff have attained the National Vocational Qualifications Level 2 qualification. Two staff files were inspected they showed that the home had undertaken all the necessary checks to ensure protection of residents. There were identity documents, two references were in place and Criminal Records Bureau Clearance and POVA checks had been undertaken. The Personal Identification Number on a registered nurses file was up to date. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live there. Evidence: The organisation has recruited a new manager who is to apply to register with the Commission. A new deputy manager has also been recruited. The manager is a registered nursing acute nursing and has attained the registered Managers award. The deputy manager is a registered nurse in mental health. Quality assurance systems are in place to elicit opinion from the residents on how the home is run. This includes surveys and there are quarterly staff meetings. A residents meeting was held on 06/08/09 and the minutes were available. Allowances are held securely and separately for people who use the service and transactions are recorded and receipted. Staff are supervised and records of this were seen in staff files. Care Homes for Older People Page 20 of 24 Evidence: The health and safety of residents and staff are ensured by the provision of mandatory training and policies on health and safety. Evidence of utility and equipment testing and maintenance were available. Not all water temperatures were being recorded at the time of the visit and management is to put this in place. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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