Care Home: Abbeville Lodge

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What the care home does well The atmosphere in the home showed that service users were generally bright and happy. Chatting to each other and to staff and socialising in their their private bedrooms with a few users in communal areas also showed how relaxed the atmosphere was. Three users went out to the garden and two staff joined them to enjoy nice weather. Visitors were chatting to their relatives, with full respect for privacy. A user met us while a senior staff member was showing us the house. She stopped and commented when the carer explained that we were inspecting the home, talking about the carer: "She is excellent. She is well trained, she knows her job and is very kind. Take my word for it." Appropriate records in users` files also helped staff to do their job appropriately. There were two folders for each user, one with daily records, summary of needs, review of care plans, records of medical interventions, activity records and other daily used records. The other one, "Good Care Planning", as they called it, contained initial assessment, a general care plan, some older letters and the other less frequently used documents. Risk assessments were also detailed. Staff files contained appropriate records showing robust checks of staff during recruitment and records of staff training. Respect for service users` dignity was judged based on staff support to service users during the visit. The staff demonstrated an exceptional level of respect and how they were appropriately prioritising their support to service users. What has improved since the last inspection? The home managed to meet all requirements set on previous inspection. Medication process was improved to a safe level. There were no offensive odours anywhere within the home. The work of introducing a shower into the home was approved to accommodate users` preferences regarding their bathing programme. Recommendations were also well addressed. Social history was now added to records for each individual. Two users confirmed that they were able to choose alternative meals at lunch times. A MUST tool was introduced to monitor users` nutrition. A quiet lounge with access from the dining room provided extra communal seating for up to 6 service users. The garden looked reasonable and three users were observed using it. Most beds were replaced. What the care home could do better: The manager will need to update their statement of purpose and service users` guide to record relevant changes in the last year including adding her name to these documents. Although medication records were accurate, the staff needed to use old MAR charts in auditing process. Recording medication brought forward from older to the newest MAR chart would make it much easier to conduct the audit. The action was agreed with the manager during the site visit, to address appropriately a user`s wish to keep his old metal bed or to replace it with a very similar model. Key inspection report Care homes for older people Name: Address: Abbeville Lodge Acle New Road Great Yarmouth Norfolk NR30 1SE     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: Dragan Cvejic     Date: 2 2 0 7 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: Abbeville Lodge Acle New Road Great Yarmouth Norfolk NR30 1SE 01493857300 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Abbeville RCH Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Eighteen (18) older people, not falling into any other category, may be accommodated. Maximum number not to exceed twenty (20). One (1) male service user who has a mental disorder, excluding learning disability or dementia, who is over the age of 65 years may be accommodated. One (1) service user, named in the Commission`s records, who is over the age of 65 years and has a diagnosis of dementia may be accommodated. Three (3) service users who are under the age of 65 years and have a diagnosis of dementia may be accommodated. Two (2) services users who have a physical disability and are under the age of 65 years may be accommodated. Care Homes for Older People Page 4 of 24 Over 65 0 1 18 0 3 0 0 2 Date of last inspection Brief description of the care home Abbeville Lodge stands within the seaside town of Great Yarmouth. The service operates from an adapted building where all of the accommodation is on the ground floor. The home was previously known as Bridge House, but changed its name with a change of ownership in the summer of 2006. Fees for the service were provided in the information pack. The home was originally established in 1993 and is a single storey building with all bedrooms off the main corridor. The home has extensive gardens that consist of one enclosed garden with a patio and seating area, and a further open lawned area. There is ample car parking at the front of the premises. 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The home continued to provide good service to service users. After revieving the service through an annual service review on last year, the home continued to provide good service for people that were cared for and supported in Abbeville. We constanly monitored the service through reporting activities. The manager was in post since January. The home filled in and sent the homes self assessment, AQAA (Annual Quality Assurance Assessment). We visited the home on 16/07/09 and spoke to 6 poeple living there, two visitors, staff and the manager. We case tracked four people who were users of the service. This means we checked the information about them contained in records and observed the care process for them at the time of visit. We also observed a senior carer administering medication and helping service users. We checked money and records of Care Homes for Older People Page 6 of 24 money kept in the safe on behalf of service users. We checked the kitchen, food storage and observed breakfast and lunch. We checked the environment by walking through the home and talked to the manager about previous requirements and how they were met. The proprietor visited the home at the same time and conducted her regular monthly checks. 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 Care Homes for Older People Page 8 of 24 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 9 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 10 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. The home provided information about services and provisions allowing users to make an informed choice, but the documents needed to be updated to reflect the recent changes. A full and comprehensive assessment was undertaken to ensure that once admitted, the users needs would be met. Evidence: The manager stated that she was just in the process of up-dating the statement of purpose with added information on recent changes, including adding her name. The report from the last inspection was available in the entrance hall. The home kept initial assessment forms for users that have been in the home for a number of years and those that moved in recently seperately. This was seen in 4 checked files. The initial assessment as a part of the initial assessment process contained information about each users social history, thus providing more relevant details used to create a care plan for each individual. Care Homes for Older People Page 11 of 24 Evidence: Meeting users needs was evidenced in their records, but also was observed during the site visit. Staff knew how to prioritise well. When a user needed staff support to go to the toilet, a staff member stopped administration of medication to help the user to the toilet, first. She also stopped on another occassion just to quickly order breakfast in the bedroom of the user who asked for it while receiving her medication. Two visitors commented that the staff were very good and that: There are enough staff on duty to help them. The staff are excellent. Food is good and they get more than enough. My mum does not always eat all they give her, as they give plenty. Care Homes for Older People Page 12 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. The home ensured service users health care needs were met and at the same time showed excellent respect for their privacy and dignity. Medication procedures were appropriate and protected service users, but could be easier to audit when the staff start to record medication brought forward from to old to the newer MAR (Medication Administration Records) charts. Evidence: Four files with care plans demonstrated that plans were accurate, detailed, consistent with daily records and risk assessments. The plans were either signed by the poeple they referred to, or by their relatives if they could not sign, but agreed for relatives to share information about their needs and care. The home kept two folders containing information about each individual. The first folder contained initial assessments, general care plans and some other personal records. The evaluation and review dates recorded here indicated that the home recently introduced a monthly review, after only 3-monthly reviews were carried out in the past. The other, working file contained summary of needs, instructions to staff how to meet Care Homes for Older People Page 13 of 24 Evidence: them, risk assessments, records of medical interventions and daily records for each service user. Daily files contained entries such as: ...likes to have two pillows. Getting up and bed time varied. One of the other checked files contained records of how the home helped a user with pressure sores. Risk assessment indicated a hazard, a district nurse was engaged to monitor and apply cream and the last entry showed the healed pressure area. Visitors commented on health care: Yes, she sees the chiropodist regularly and staff even paint her nails. Medication process was recently reviewed. During the inspection a senior staff member was observed administering medication and records of four case tracked users were checked. The whole process was safe. However, it was not easy to carry out an audit, as the older MAR charts needed to be checked. The home could introduce recording brought forward medication on the currently used chart to enable easy audit and imrpove furter protection of service users, by minimising potential errors. The excellent respect for users dignity was observed on several instances during the site visit. A senior staff member quickly stopped administrating medication to a user, as she wanted her breakfast in her room. The senior staff member popped to the kitchen and ordered breakfast for the user in her room and then continued with administration of medication. She stopped briefly again to help a user who needed to go to the toilet. Two other staff followed three users in the garden and respectfully and cheerfully chatted with them there. Several users stated that staff were excellent. Care Homes for Older People Page 14 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. Daily living routines at the home were flexible. Both individual and group activities have been improved as the home employed an activity coordinator. Nutrition of service users was better organised, monitored and resulted in better satisfaction of service users. Evidence: Flexibility and a relaxed atmosphere in the home were visible during the site visit. A daily routine that the suited needs of service users was noticed by visitors, too. Two visitors, that visited the home on a weekly basis explained that the routine was appropriate for users abilities and that it did meet users expectations. One of the users spoken to stated that he was not keen on communal activities, but was more than happy to have the opportunity to read newspapers among other users and to watch news and sport in his room. Another user, less mobile, also stated that she simply did not want to sit in communal areas and preferred to be in her room, watching TV and reading. However, she liked her door open and was able to see staff and some other users in a corridor, while relaxing with newspapers, a couple of magazines and a book next to her. Three service users were chatting in the garden. The home employed an activity coordinator and she engaged more users in organised Care Homes for Older People Page 15 of 24 Evidence: activities. However, the main characteristic of the home was that users preferred to stay in their room to talk to one another, rather than to spend time in the big communal lounge. The activity coordinator respected this wish and, apart from bingo and quiz, she also offered a one to one chat to the users in their rooms. Two users stated that they enjoyed having their nails manicured and painted. meal times, especially lunch was the time when they gathered in the dining room and spent time together. Lunch was observed. Ten users were there and the kitchen staff called users names and asked carers to serve individually made plates. Good knowledge of users wishes and preferences helped create individualised portions. All service users spoken to stated that they were happy with food and that alternative meal was always provided when they asked for it. Fresh fruit was on the table in dining room throughout the site visit. Staff also ensured users always had a fresh fruit juice in their bedrooms. Care Homes for Older People Page 16 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. Service users were protected by the procedures set and respected in the home and with their own knowledge of the complaints procedure. Evidence: The written complaint procedure was displayed next to the entry to the home and was clear and accessible. POVA (Protection of Vulnerable Adults) training was added to the planned training and, after half of the staff already attended this training the other half were on the list for September when the next session was planned, thus ensuring better protection of service users. Four recorded complaints came from the same person and the final outcome of the action undertaken after the investigation was satisfactorily received by the complainant. There were no allegations or issues requiring referrals to POVA register. Staff were aware of the procedure and two of them spoken to during the site visit stated that they knew about Whistle blowing policy. Care Homes for Older People Page 17 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. Service users live in a well maintained and comfortable environment, with a range of equipment to help them keep independent. The home acted upon users wishes and was in the process of installing a shower. Evidence: The physical environment of the home is suitable for service uses. They had access to all parts of the home. Recently, some older type beds were replaced. Some bedrooms were redecorated and the manager explained the plan to decorate corridors and was planning how to minimise disruption to service users. Employing a cleaner on a 5 hours/day basis helped the home maintain a clean and odour free environment. Two visitors stated that they chose this home for their relative as it was odour free. A senior carer explained the procedure for disposal of clinical waste and demonstrated that staff were familiar with the this infection control measure and generally worked well to ensure hygiene and infection control were in place. Care Homes for Older People Page 18 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 home ensured safety for service users by employing sufficient, trained and appropriately vetted workers, creating a rota that corresponded to users identified needs. Evidence: Observing staff during the site visit demonstrated that staff knew their roles and worked in an organised and structured way, thus ensuring they responded to the service users needs. Meal times also showed that there were enough staff to help users who needed help. Three staff files were checked during the inspection.All required checks were conducted and files contained the application form, two references, CRB (criminal Records) and POVA (Protection of Vulnerable Adults) checks. Staff induction was expanded to include training on POVA and dementia care. Training records showed that staff received regular update training on mandatory subjects and extra training included subjects such as Basic life support, Diabetes and Dementia. Training towards NVQ qualifications was promoted and currently two senior carers were doing their NVQ 3 and all new staff were on NVQ 2 training. 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. Service users were well protected by the safe working practices in place. Evidence: The manager was working in this position since January and ensured stability and consistency in the day-to-day operation of the home. She recently was trained on Diabetes and reproduced this training for staff. The pleasant, relaxed and respectful atmosphere in the home contributed to the users satisfaction and protection. Safe working practices were in place. Observation of staff working with users of the service demonstrated that staff were confident in applying the set procedures to protect service users. The tour of the home showed that cleanliness and measures for infection control were in place. Accidents/incidents were properly recorded and reported when there was a need to report. When there was a need, the home helped service users with their personal allowances. The records of money kept in a safe on behalf of service users were Care Homes for Older People Page 20 of 24 Evidence: checked and two records were audited and were accurate. Three service users stated that they were happy to be helped to manage their finances. The home used questionnaires for their quality assurance assessment. The manager explained her plans to introduce service users meetings as another form of collecting their opinion in addition to the open door principle. Two service users came to the office to see the manager during the visit, confirming that they were able to provide comments, suggestions or to express their concerns. Since the new manager started in January, there was a supervision plan for staff and at least 2 sessions were already held with each staff member. Improved training and refresher courses of all mandatory subjects and clear procedures made the home safe and protected service users. 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 1 1 The statement of purpose and service users guide should be updated to include changes that happened in the home, including providing the new managers name. Medication carried over from one to another sheet should be recorded on the current sheet to ensure easier audit and better protect service users. 2 9 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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