Care Home: Abbcross Nursing Home

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What the care home does well The home now has a very experienced manager and dedicated staff team that are committed to the residents and the quality of the care they receive. Thehome has a very relaxed and welcoming atmosphere and is clean and tidy. Residents and relatives all spoke about Abbcross as being a nice place to live. It was evident that the home is run in the best interests of the residents. Every effort is made to ensure that their views and of their families and friends are taken into account on any decisions in relation to the running of the home. Residents and relatives were very complimentary of Abbcross relatives comments were "The care my Mum has is very good", "they are all doing a brilliant job", "I am very happy with Abbcross, everyone works for the benefit of the residents". Residents comments were, "I am really happy here, the girls are really nice", "It`s not the same as your own home but it`s the next best thing", "I feel safe and well looked after". A social care professional stated, "I found the environment to be homely; the staff were friendly and welcoming and interacting with the residents in a nice manner". What has improved since the last inspection? Abbcross has made significent progress since the last inspection (December 2007). At the last inspection and a subsequent Pharmacy inspection twelve Requirements and five Recommendations were identified. All of the Requirements and four of the Recommendations have been met. Residents` care plans are currently being reviewed and are now more comprehensive and person centred. Daily records are more informative and relate to residents` care plans and health monitoring is being completed appropriately. Two of the care staff have designated hours to arrange and undertake activities with the residents. These activities are undertaken in groups and with individual residents. Staff training has also taken place with nurses undertaking medication awareness and stoma care and care staff attending Safeguarding Adults as well as other mandatory training. An annual development plan has been developed that reflects the aims and outcomes for the residents. From this inspection it is noted that the handling, administration and recording of medication at Abbcross has significantly improved. Medication Administration Record (MAR) charts are being completed appropriately. The medicines storage room is tidy and all medicines are stored in the medicines cupboard. All liquid medicines have the first date of opening recorded on the bottle and the medicines fridge temperatures are being recorded daily with a functioning thermometer. A larger Controlled Drugs cupboard has been ordered and the Controlled Drugs register is being completed with the recording of a witness signature. The home now has available the correct disinfectant granules for dealing with blood spillage and these are kept with the protective gloves and glasses. What the care home could do better: There are no Requirements and two Recommendations identified from this inspection. The recommendations are for the Service User Guide to be produced in a pictorial format and that future Quality Assurance surveys are sent to stakeholders (health professionals, local authority commissioning officers and social workers) CARE HOMES FOR OLDER PEOPLE Abbcross Nursing Home 251 Brentwood Road Romford Essex RM1 2RL Lead Inspector Julie Legg Announced Inspection 7th April 2008 10:00 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 Abbcross Nursing Home DS0000015582.V361396.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. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbcross Nursing Home Address 251 Brentwood Road Romford Essex RM1 2RL 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) 01708 438 343 01708 438 343 abbcross@haveringcare.co.uk Havering Care Homes Limited vacant post Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2007 Brief Description of the Service: Abbcross Nursing Home provides nursing and personal care to 28 older people. It is situated in a residential part of Romford, and is in keeping with other local properties. A bus route, which goes into the town centre, passes directly in front of the home, which is approximately 15 minutes walk from the nearest railway stations. The house is a large, detached, three storey building, with parking to the front and a garden to the rear. There are 24 single and two double bedrooms, all of which have en-suite toilets, and these rooms are situated on all three floors of the building. There is a lift to the two upper floors. There is an assisted bathroom on the first floor, an ordinary bathroom on the upper floor, and a shower room on the ground floor. The home provides nursing and personal care on a 24-hour basis, and there is a Registered Nurse on duty at all times. Specialist health needs are met by visiting professionals, and social activities are organised within the home by the care staff. The current scale of charges are £557.00 to £800.00. Additional costs for items such as hairdressing, chiropody and newspapers etc. Information is made available to prospective service users via a Service Users Guide. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This inspection took place over one day. The manager was present for the duration of the inspection and was available for feedback at the end of the inspection. Discussions took place with the registered provider, the manager, two nurses, care staff, the administrator, the chef and domestic. Care staff were asked about the care residents receive and were also observed carrying out their duties. The chef was asked about the meals she provided to the residents and their likes and dislikes. Staff were also asked about their recruitment, induction programme and their ongoing training. Further information about Abbcross was also gathered from residents, relatives and social care professionals. A tour of the home was undertaken and all of the rooms were seen to be clean and free from any offensive odours. Residents’ files were also examined and case tracked: including risk assessments and care plans, together with the examination of staff files and other home records. These records included medical charts, financial transactions, and staff rotas and staff record Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment, Regulation 37 notifications and Regulation 26 reports. We had a general discussion on the broad spectrum of equality & diversity issues and the manager was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector also had a discussion with the manager, residents and staff as to how the people living at the home wished to be referred to in this report. They expressed a wish to be referred to as ‘resident’. This is reflected accordingly throughout this report. The inspector would like to thank the residents, manager and staff for their input during this inspection. What the service does well: The home now has a very experienced manager and dedicated staff team that are committed to the residents and the quality of the care they receive. The Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 6 home has a very relaxed and welcoming atmosphere and is clean and tidy. Residents and relatives all spoke about Abbcross as being a nice place to live. It was evident that the home is run in the best interests of the residents. Every effort is made to ensure that their views and of their families and friends are taken into account on any decisions in relation to the running of the home. Residents and relatives were very complimentary of Abbcross relatives comments were “The care my Mum has is very good”, “they are all doing a brilliant job”, “I am very happy with Abbcross, everyone works for the benefit of the residents”. Residents comments were, “I am really happy here, the girls are really nice”, “It’s not the same as your own home but it’s the next best thing”, “I feel safe and well looked after”. A social care professional stated, “I found the environment to be homely; the staff were friendly and welcoming and interacting with the residents in a nice manner”. What has improved since the last inspection? Abbcross has made significent progress since the last inspection (December 2007). At the last inspection and a subsequent Pharmacy inspection twelve Requirements and five Recommendations were identified. All of the Requirements and four of the Recommendations have been met. Residents’ care plans are currently being reviewed and are now more comprehensive and person centred. Daily records are more informative and relate to residents’ care plans and health monitoring is being completed appropriately. Two of the care staff have designated hours to arrange and undertake activities with the residents. These activities are undertaken in groups and with individual residents. Staff training has also taken place with nurses undertaking medication awareness and stoma care and care staff attending Safeguarding Adults as well as other mandatory training. An annual development plan has been developed that reflects the aims and outcomes for the residents. From this inspection it is noted that the handling, administration and recording of medication at Abbcross has significantly improved. Medication Administration Record (MAR) charts are being completed appropriately. The medicines storage room is tidy and all medicines are stored in the medicines cupboard. All liquid medicines have the first date of opening recorded on the bottle and the medicines fridge temperatures are being recorded daily with a functioning thermometer. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 7 A larger Controlled Drugs cupboard has been ordered and the Controlled Drugs register is being completed with the recording of a witness signature. The home now has available the correct disinfectant granules for dealing with blood spillage and these are kept with the protective gloves and glasses. What they could do better: 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. Abbcross Nursing Home DS0000015582.V361396.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 Abbcross Nursing Home DS0000015582.V361396.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): 1,3,4 & 5 People who use 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. Prospective residents and their relatives have detailed information on the home, which assists them to make an informed choice about moving into the home. A pre-admission assessment is undertaken of all prospective residents and they and their relatives are able to visit the home prior to their admission. This will ensure that the home and the prospective resident know that their needs can be met. EVIDENCE: The Statement of Purpose sets out the objectives and philosophy of the service and states clearly what the home can provide. This document is regularly Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 10 reviewed and updated. The Service User Guide is informative and written in plain English and is available in large print. It would be good practice if the Service User Guide was also produced in pictorial format. This is Recommendation 1. The files of three residents were looked at. The manager had undertaken a pre-admission assessment and has also gathered information from the family and health professionals, as well as being in receipt of an assessment that had been carried out by the funding authority (if appropriate). From the assessment and other relevant information, a care plan is drawn up which identifies the resident’s needs (see standard 7). Residents and relatives are encouraged to visit the home prior to a resident moving in. the majority of the visits are undertaken by relatives due to the frailty of the residents. One resident stated, “I was able to visit the home with my family, I felt really welcomed and nothing was too much trouble, they showed us around the home and was able to answer all of the questions. I have definitely made the right choice”. Another residents stated, “My daughter visited several homes and she preferred this one. I think she made a splendid choice and I am very happy here”. A relative stated, “I had to choose the home for my dad and I found it quite daunting. I felt the most comfortable here. The atmosphere was good, staff were sitting talking to residents, who all looked well cared for”. Another relative stated, “I visited several homes before choosing Abbcross but Helen (manager) made us feel very welcome and we felt the home had a good atmosphere” Abbcross Nursing Home DS0000015582.V361396.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 People who use 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 health, social and personal care needs of each resident are set out in individual care plans. These care plans are comprehensive and person centred, which ensures that the residents receive appropriate care to meet their needs. There are medication policies and procedures for staff to follow and the home’s medication systems and practices are now robust which ensures that residents are not put at risk. Residents are treated with respect and dignity and the arrangements for their personal care ensures that their right to privacy is upheld. There is information regarding residents’ wishes in relation to their death and the staff are currently completing ‘preferred place of care’, this will ensure that residents’ wishes concerning their final days are carried out. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has their own care plan, four of these care plans were examined. There is a vast improvement in the care plans since the last inspection; the manager has commenced reviewing all of the care plans and those that have been reviewed are comprehensive and person centred. The care plans identify the residents’ personal, social, health, cultural and religious needs, as well as likes and dislikes and fears for the future. They also identify essential things or routines that are important to the resident such as ‘A likes to have a bath in the morning before breakfast’, B likes to read the daily newspaper after breakfast’. These plans have been developed with the involvement of the residents and relatives and are now working documents that are easily read and understood by care and nursing staff. Daily logs are being written and there has been an improvement in the information that is recorded. The daily logs are now an accurate reflection of the care the resident has received and relate to the residents’ care plans. As stated earlier in one resident’s care plan ‘A likes to have a bath in the morning before breakfast’. The daily log evidenced that this had happened. Care plans examined showed referrals to specialist health care professionals, such as, diabetic nurse specialist and tissue viability nurse. There were care plans relating to specific health needs such as, management of diabetes, indwelling catheter, weight management and pressure care. Records indicated that residents have access to GP, dentist, optician, chiropodist and hospital outpatient appointments. The Speech & Language therapist was visiting Abbcross the day following the inspection to review the residents who are on pureed diets and to talk to the staff. Residents and relatives confirmed that appropriate action is taken when health care professionals are required. Residents are weighed on admission and then generally on a monthly basis. Where there have been concerns, such as weight loss due to reduced appetite, the GP has been advised and the resident’s weight has been monitored weekly or fortnightly. A number of monitoring charts were examined, including blood sugar monitoring and food/fluid intake and output monitoring charts. Blood sugar monitoring was being undertaken as directed and all of the food/fluid charts were being correctly recorded; amounts of fluid was being recorded in millilitres and food was being recorded in tablespoons or the size of the serving (one slice of bread etc). The accident and incident book was reviewed. Accidents were recorded in full, and residents received follow up checks to ensure there were no further health associated risks, and follow up sheets were completed, which were counter signed by the manager. The Commission for Social Care Inspection has been informed of these incidents and accidents in line with Regulation 37 Notifications. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 13 Risk assessments were examined; those seen were detailed and covered areas such as, personal safety/protection, diet/fluid intake, skin pressure area care and use of hoists, wheelchairs and bedrails. There was evidence that risk assessments are being regularly reviewed and updated. Medication policies and procedures were examined and found to be up to date. The manager advised the inspector that the home has recently changed Pharmacist, as they were able to provide a more comprehensive service and have also provided training to the staff. Only nursing staff can administer medication. Four residents’ medication was checked against the Medication Administration Records (MAR) charts. The charts had been completed appropriately and the amount of medication remaining was correct. Liquid medication was checked and all bottles had the date recorded of when first opened written on the label, this will ensure that usage does not go beyond the in-use shelf life. Previously there had been a practice of decanting between packs of tablets. Packs of tablets were examined and there was no evidence that strips of tablets had been decanted into other packs. The medication storage room was inspected; the room was very tidy with all medicines stored in a locked medicines cupboard. The medicines fridge storage temperature records were correct and up to date. The Controlled Drugs register was examined and as previously stated on page 113 of the CD register on 28/06/07 there was no witness signature to the destruction of MST 30mg sachets. Since the 28/06/07 all entries have been appropriately recorded with the signature of a witness. The home is now carrying a larger amount of Controlled Drugs and a larger cupboard was required, this has been ordered. The home now has available the correct disinfectant granules for dealing with blood spillage and these are with protective gloves and glasses. From this inspection it is noted that the handling, administration and recording of medication at Abbcross has significantly improved, this ensures that residents are not put at risk. The inspector spoke to a number of residents and relatives who all stated that staff were respectful when attending to their personal care. One resident stated, “The girls are very nice and are gentle when helping me to have a bath”, another stated, “the staff are very caring, they never rush me”, another commented, “The girls always knock on my door before they come in”. One relative commented, “The staff are very kind and Mum thinks they are wonderful”, other comments from relatives: “My dad is a very proud man and they are very aware of preserving his dignity especially when helping him with his personal care”, “The care my Mum had was wonderful and we were able to leave after visiting with the assurance Mum was being well looked after”. A social care professional stated,“C appears to have settled very well at Abbcross, she appears brighter in mood and her appearance”. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 14 Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as, in the way they addressed residents and when entering bedrooms, bathrooms and toilets. They were seen to be gentle when undertaking moving & handling tasks and offered explanation and reassurance throughout the activity. One resident asked for the television to be turned to another channel, a member of staff was seen asking two residents if they were watching the programme and when they said ‘no’, she asked if she could switch over to another channel. The wishes of some of the residents regarding their death and the arrangements they want after their death have been sensitively discussed with the residents (where appropriate) and relatives. The staff in conjunction with the residents and relatives are completing the ‘Preferred Place of Care’ and details of the NHS ‘end of Life’ co-ordinator were given to the manager. One relative had written ‘words cannot express our sincere thanks to you and all of your staff for the kindness, compassion and care shown to our Mum during the final days of her life and for the way you and your wonderful staff looked after all the family on the day Mum died’. Abbcross Nursing Home DS0000015582.V361396.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 People who use 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 activities programme has improved and is now more varied and further work has been undertaken to ensure that activities are tailored to meet individual needs and preferences. Visiting times are flexible and people are made to feel welcome when visiting the home. This ensures that residents are able to maintain contact with their families and friends. Residents are helped to exercise choice and control over their lives, which enables them to retain as much autonomy as possible. The meals have continued improved in presentation and choice and residents are afforded flexibility of meal times. EVIDENCE: Residents were asked their views and care plans were examined. There is a general programme of activities available for all of the residents and regular Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 16 visits by professional entertainers also take place. Monthly activities have included a strawberry cream tea, BBQ, Halloween, Bonfire Night, and December has been a particularly busy month with entertainers, carol service and mulled wine and mince pies and at Easter the residents made Easter cards and made chicks and painted ceramic chickens. On the day of the inspection the residents had decorated flowerpots and were planting sunflower seeds. Even the residents who prefer to spend time in their own room had taken part in this activity. There is a regular church service at Abbcross and the parish priest also carries out pastoral visits. Some of the residents have Communion bought to them and the ‘mother’s union’ from the Church of Our Lady also visit regularly. All of the residents have a special tea and cake on their birthday. Comments from residents were “We really enjoyed making the bits and pieces at Easter and my daughter liked her card”, “We are now doing quite a lot of activities, the staff have asked us what we want to do”, “It’s better than just sitting waiting for God”. Two of the residents were keen gardeners and they are now advising the manager on plants for the garden. Staff (including the domestic, the maintenance man and the administrator) were also seen spending time sitting and talking to residents. Daily activities include reading, talking books and newspapers, board games and bingo nights as well as watching television and listening to the radio. Two of the care staff has recently taken on the roles of activity co-ordinator and they are meeting with residents and relatives to look at the type of activities residents wish to see within the home. There has been an improvement in the overall activities that are offered to the residents and the residents’ individual activity care plans have adequate information and a more person centred activities programme is currently being developed. The signing-in book shows that there is a steady stream of visitors to the home on most days; indeed on the day of the inspection six residents received visitors. Visiting times are very flexible and visitors confirmed that they could visit at any time. Residents have the choice as to whether they see their visitors in the lounge, the garden or the privacy of their own bedroom. All of the relatives that were spoken to said that they were made to feel very welcome. The manager has set up a small table in the corner of the lounge with tea and coffee making facilities for the relatives. Residents’ care plans indicate their preferred name and their wishes regarding their death. Residents are encouraged to handle their own finances and this they do with the support of their families. The home holds small amounts of cash for hairdressing, chiropody and other sundries. Residents are encouraged to bring some of their own possessions into the home and this was evident when visiting residents’ bedrooms. Some residents have a telephone in their bedroom. Residents’ meetings are taking place and they are making decisions regarding menu planning and activities. The inspector was able to observe members of staff allowing residents time to express their wishes and Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 17 supporting individuals to make choices in their daily lives, such as, choosing a drink and their meal for lunchtime. Meals are mostly served in the dining room, though some residents take their meals in their bedrooms if they wish. A visit was made to the kitchen and the inspector was able to discuss menus and the storage and preparation of food with the cook. There is a four weekly menu and each day there are two choices of the main meal. Menus are now provided in large print as well as the daily menu board and the manager is looking to provide pictorial menus. Menu forms are completed daily with each resident. The cook was aware of special dietary needs and the likes and dislikes of the residents. A cooked breakfast is available at weekends, which includes bacon, sausage and eggs. On other days there is a choice of cereals, toast, porridge and yoghurts. On the day of the inspection the choices for lunch were meatballs or steak & kidney pie (both homemade), mashed potatoes, carrots and green beans, followed by apple crumble and custard, yoghurts or fresh fruit. Tea time there was a choice of soup, sandwiches, and salad, egg on toast or sausages and mash followed by fresh fruit, choc-ice or ice cream. Snacks and drinks are also offered during the day. A resident stated “Sometimes I have a small sandwich before I go to bed”. A relative stated, “I sometimes visit at tea time and everyone seems to have enough to eat, my Dad says the food is good”. Abbcross Nursing Home DS0000015582.V361396.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 People who use 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’s complaints policies and procedures provide the residents and their relatives with the appropriate information to ensure that their concerns and complaints are listened to and acted upon. There are policies and procedures on adult protection and staff have received training in safeguarding adults to ensure that there is an appropriate response to any allegations of abuse. EVIDENCE: The complaints book was examined and there had been 4 complaints since the last inspection (December 2008). All of the complaints have been dealt with appropriately and have been resolved to the satisfaction of the complaint. The complaints procedure is on the notice board and residents and relatives were asked, “If you were unhappy about anything in the home, who would you talk to. All of the relatives stated, “They would talk to Helen (the manager). One of the relatives stated, “If I have any concerns I go straight to Helen, she takes on board what I am saying and deals with it. I have had an ongoing issue with my Dad’s laundry and she is the only person who has dealt with it”. A resident Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 19 stated, “I have no complaints but if I did I would talk to the manager or one of the nurses”. All of the residents have relatives/friends who visit and there are resident and relative meetings. The manager stated she operates an open door policy and welcomes any suggestions, concerns and complaints as she feels this can only improve the service that is being provided at Abbcross Nursing Home. The Commission is confident that the manager would take any concern/complaint seriously and would deal with them appropriately. The home has policies and procedures for the safekeeping and expenditure of residents’ monies and all monies are held securely within the home. The majority of families or representatives administer the residents’ finances. The home holds small amounts for hairdressing, chiropody and toiletries. Three of the residents’ monies were checked and all were accurate with receipts tallying with the amount of money spent. Medication records are up to date, medication records are being completed appropriately, the administration of medication is being complied with and all nursing staff have received up to date training in the administration of medication. There is a written procedure and policy for dealing with ‘safeguarding adults’ and whistle blowing. The home also has a copy of the department of Health ‘No Secrets’ and the local authority (London Borough of Havering) documentation on safeguarding adults. The manager was clear in what incidents needed to be referred to the Local Authority as part of the local ‘safeguarding adults’ procedure. There has been one ‘safeguarding adults’ incident reported since the last inspection. This was reported and dealt with appropriately and disciplinary action was taken. Staff have undertaken appropriate training and were aware of the actions to be taken if there were any concerns regarding the welfare and safety of the residents. Safeguarding adults is regularly reinforced and discussed through staff meetings. Abbcross Nursing Home DS0000015582.V361396.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): 19,20,21,23,24,25 & 26 People who use 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 homely and provides the residents with a clean, safe and comfortable environment. Residents’ bedrooms suit their needs are decorated and furnished in a way that suits them. EVIDENCE: A tour of the home was undertaken including residents’ bedrooms. The home is situated on a busy residential road; facilities within the community are accessible. The home is decorated and furnished in a homely fashion and all areas of the home were maintained, clean and free from any offensive odour. The home has an infection control policy and would seek advice from external specialists if and when required. A visit was made to both of the laundry rooms Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 21 and the kitchen. There are two laundry rooms, one is situated inside the main building and the other is situated in the external premises at the side of the building. To access these laundry facilities staff have to leave the main building and walk across to the external laundry room. Laundry staff are required to access this laundry many times during the day and evening transferring laundry down two steps and transport them in an old wheelchair. Outside lighting and a security pad have now been installed on the back door and a risk assessment has been completed. The registered provider is looking at ramping the back steps and providing a more suitable container to transport the washing. The kitchen has been redecorated and refurbished with fitted cupboards, a new cooking range and new flooring. Food within the refrigerators and freezers was appropriately stored and labelled and refrigerator and freezer temperatures are regularly recorded. The kitchen is quite small and there is limited storage space. There are additional facilities for storage, including a freezer, which is situated in an outbuilding. To access this storage the cook has to leave the main building and walk round part of the outside perimeter. Outside lighting and a security pad has been fitted on the kitchen door and a risk assessment has been completed. There are a sufficient number of toilets and bathrooms. There is a shower room on the ground floor, which most of the residents are unable to access, as there is a deep step into the shower itself. Building contractors have been contacted and work is to commence very shortly on the shower room so that it is wheelchair accessible. There is a specialist bath in the bathroom on the first floor. This specialist bath is not an immersion bath but has a shower facility. The door to this bathroom opens on to the landing, this has been altered as the bathroom is small and just about accommodates the specialist bath and a hoist. However staff have to leave the door open and use a portable screen to afford privacy when transferring the resident from hoist to bath. When the hoist is moved out of the bathroom and back on the landing, only then are staff able to remove the screen and close the bathroom door. Staff that were spoken to were very aware of ensuring residents’ dignity at all times. There is a bathroom on the second floor, which can be used by residents who require the use of a hoist, however the majority prefer to use the bathroom on the first floor. The living area of the home consists of a large lounge/dining room; this is a bright and airy room with sufficient armchairs. This room was redecorated just before Christmas and new carpets have been fitted. Residents were involved with choosing the colour of the carpet and curtains. There are sufficient dining room tables and chairs, however not all of the residents eat at the dining room table but prefer to have their meals on small tables in front of them. One resident was asked if that was her choice to eat off a small table, she replied, “I much prefer to sit in my armchair, I am more comfortable”. The manager is Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 22 looking at the layout of the lounge/dining room to ensure the room is fully utilised. All of the bedrooms have en-suite toilets, several of these rooms have been redecorated and new curtains and carpets have been fitted. All of the bedrooms are appropriately furnished, personalised and reflective of the residents’ interests, culture and religion, with ornaments, pictures, photographs, televisions and radios. The central heating system has also been completely overhauled. The garden is well maintained and the residents make full use of this facility during the warm weather. Some of the residents commented that they enjoyed sitting out in the summer and two of the residents are assisting the manager with the replanting of the flowerbeds. The home is cleaned on a daily basis and throughout the inspection all areas of the home, the standard of cleanliness was very good. There are adequate control systems in place to ensure that the home is free from any offensive odours. All domestic staff have attended infection control training. Residents and relatives were very complimentary of the cleanliness of the home; comments were “there are never any unpleasant odours as you walk in”, “the home is always lovely and clean” and “the domestics work hard in cleaning the home to a high standard”. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 23 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 People who use 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’s staffing levels are satisfactory and there are sufficient staff on duty and the staff have the appropriate skills and training to meet the individual needs of the residents. The home has a clear recruitment policy and procedure and all appropriate checks are undertaken, which ensures the safety and protection of the residents. EVIDENCE: The staffing levels of qualified nurses and care staff are sufficient to meet the nursing and care needs of all the residents. Staff were being deployed effectively to ensure that residents choosing or needing to remain in their bedrooms were being cared for appropriately. The duty rota was examined and this concurred with the designation and number of staff on duty at the time of the inspection. The home is fully staffed; any bank staff that are used are employed on a regular basis, which offers the residents continuity of care. In discussion with the manager and staff at all levels, it was apparent that staff morale has greatly improved and they are enthusiastic and positive about wanting to improve the quality of life for the residents. Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 24 There is a robust recruitment and selection procedure, which ensures the protection of residents. Files of the most recently recruited staff were examined and these were found to be in good order. All had completed an application form and the manager questioned any gaps in their employment history. Every applicant also completed an equality & diversity monitoring form and were asked the same set of questions and their answers recorded. Criminal Records Bureau (CRB) checks were undertaken; two satisfactory references and other employment checks were undertaken prior to staff commencing their employment. Four members of staff were spoken to and all confirmed that these checks had taken place prior to them commencing work. Abbcross employs a workforce from diverse cultures and backgrounds, some of which are different from the residents living in the home. However, staff have undertaken training in equality & diversity. This ensures that the spiritual, cultural, sexual and any other diverse needs of the residents at Abbcross are understood by staff and appropriately met. All newly appointed staff undertake eight-week induction training, which is in line with the Skills for Care Programme. Further training that has been undertaken since the last inspection includes; health & safety, safeguarding adults, medication management, moving & handling, care of the dying and stoma care. Further training has been organised in: dementia awareness, moving & handling, pressure skin care and awareness of swallowing difficulties. There are 13 care staff, seven have attained their NVQ 2 or above and five care staff are currently undertaking their NVQ 2; this means that 92 of care staff will have attained a formal qualification. The manager is currently developing training plans for all members of staff. As stated earlier two of the care staff have taken on the role of the activity coordinator. The two care staff have split the fifteen hours between them and when working these hours they are supernumerary to the number of care staff on duty. Residents and relatives comments were very complimentary of the staff; “All of the staff are caring and friendly, nothing is too much trouble”, “I have never heard a member of staff even raise their voice to a resident, they are patient and allow the residents time to explain what they want”, “the girls are really nice and find the time to have a chat”. Staff also spoke positively about working at Abbcross, “I really enjoy coming to work”, “I have worked at other homes but this is the best”, “we do try and work as a team and this can only benefit the residents”. Abbcross Nursing Home DS0000015582.V361396.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, 33,35 & 38 People who use 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 has an experienced and qualified manager, who has sound management practices. This means that residents’ health and welfare are protected and promoted. Residents can be confident that their views underpin the self-monitoring, review and development of the service. EVIDENCE: The manager is a registered nurse and has the relevant clinical and management qualifications (Registered Manager’s Award) and has many years Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 26 experience in providing and managing care services. She has been in post since February 2008 and is currently applying to the Commission to become the registered manager of Abbcross Nursing Home. There is an Annual Quality Assurance programme. Residents and relatives’ views have been sought on the quality of the service being provided. These views have been sought through satisfaction questionnaires, residents and relatives meetings and the complaints and concerns records. Completed surveys were seen, which had been sent to residents and their families and friends. Overall the responses to the questions were very positive and where there was dissatisfaction within the service (quality of meals and activities) these areas have been looked at and there is evidence that both of these areas have significantly improved. Residents and relatives also stated that there has been an improvement in the quality and quantity of the meals and in activities. The Quality Assurance survey was not sent to stakeholders who visit the home (social service, specialist nurses, GP and other health professionals); it would be beneficial to the home to know their views of the service being provided at Abbcross Care Home. This is Recommendation 2. Discussions with the manager showed she was able to describe a clear vision for the home, particularly in relation to continuous improvement of the service. The manager has carried out ‘spot checks’ outside of ‘normal hours’ and feedback from residents and relatives and other quality monitoring system has enabled her to gather information. This information has fed into the home’s development plan that reflects the aims and outcomes for the residents. Regulation 26 visits are undertaken by the Responsible Individual to monitor and report on the quality of the service being provided. The inspector saw these reports during the inspection and they are providing the information that is required. Areas of concern are recorded and the Registered Individual has shared his concerns with the manager and has drawn up an action plan, to ensure these areas are dealt with. The Commission receives Regulation 37 notifications, which advise us of any significent events within the home. The home has an appropriate policy and procedures regarding the safeguarding of residents’ finances. Currently neither the manager nor any member of the organisation acts as an appointed agent for any of the residents. Three of the residents’ finance records were checked and all amounts accounted correctly and were in order. The manager had stated that she had an open door policy with residents, relatives and staff and that she likes to have presence on the ‘floor’ of the home. During the course of the inspection the manager was observed directly engaging with residents, relatives and staff. Staff were complimentary, saying that though she had only been at the home for a short while, she had already Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 27 made a difference. Comments were “I really enjoy coming to work”, “we really feel valued and she asks us for our opinions” and “I feel really supported”. A wide range of records were looked at and these were found to be detailed up to date and accurate. Those records looked at included fire safety, emergency lighting, water temperatures checks, gas and electrical checks, hoists servicing, Portable Appliance Test (PAT), lift and hoist maintenance. These were found to be up to date. Staff have undertaken moving & handling training and risk assessments are updated yearly or when there is a change or a new risk is identified. Abbcross Nursing Home DS0000015582.V361396.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 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP8 Good Practice Recommendations It is recommended that the Service User Guide be produced in a pictorial format. It is recommended that the Quality Assurance survey be sent to stakeholders who visit the home. 2. OP33 Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Abbcross Nursing Home DS0000015582.V361396.R01.S.doc Version 5.2 Page 31 - 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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