Care Home: Abbey Court Nursing Home

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What the care home does well Abbey Court Nursing Home remains committed to shaping the services around the views and needs of the people that use the service. They make great efforts to meet the wishes and needs of the people living in the home and their families. Care plans are created for each individual and are reviewed on a monthly basis with some input from the individual and their families where appropriate. The home regularly send out themed Quality Assurance Questionnaires to people using the service, relatives and visiting professionals. These questionnaires are always available next to the signing in book and are designed to be anonymous if preferred. Management encourage the staff of Abbey Court to record any grumble or suggestion for improvement on these forms. They find this is an effective way of making adjustments to the way in which the home is run to the benefit people living and working in it. The ethos of Abbey Court is to be flexible and responsive and daily feedback is sought from each and every person, visitor or member of staff. The home manager walks around the home a number of times each day talking to each people living in the home, their families and the staff. The Directors of the home also visit very regularly and ensure that they speak to people in the home to get an accurate view of the quality of the service provided and to act upon any suggestions that are given to them by the residents or their family members. The home have an open door policy at where the manager and the Directors of the home are always available to spend time with the residents or their families to answer any queries they may have or simply to provide information about specific medical conditions. The management continue to closely monitor the menus and make changes where desired by our individuals. They are aware that it can be difficult to meet each individual tastes on a daily basis. For this reason they have a very extensive list of alternatives. The head chef regularly speaks with each of the persons using the service, following initial survey of dietary requirements and ensures that menus are updated in accordance with their wishes. The home offers a variety of activities and events which is suitable for most people in the home. The mangers are looking to introduce and further develop the social care plan as part of evidencing that individual needs are being met in the home. What has improved since the last inspection? The Operations Manager regularly carries out audits and Regulation 26 visits and carries out unannounced inspections of the home. She also visits and carried out thematic inspections and will focus on a particular area e.g. Care Planning. The deputy manager has now completed her NVQ Level 4 in Leadership and Management. We have introduced a number of new forms that are designed to improve communication between the nursing shifts and the manager and also to better track the outcomes of GP visits etc. What the care home could do better: The management plan to Continue with their Annual Development Plan. Try to improve attendance at relatives meetings. Continue to monitor and update Policies and Procedures. Continue with internal auditing and use the feedback to improve our service. To further develop the Resident led Forum. Several issues identified by the Pharmacy Inspector were raised however the management had actioned these immediately. Recommendations left at this visit were discussed with the management during feedback at the end of the visit. Key inspection report Care homes for older people Name: Address: Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS11 7AD     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: Joanna Wooller     Date: 1 1 0 5 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS11 7AD 01543277358 01543277876 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Restful Homes (Cannock) Limited Name of registered manager (if applicable) Miss Sarah Edwards Type of registration: Number of places registered: care home 117 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: The maximum number of service users who can be accommodated is: 117 The registered person may provide the following category of service only: Care Home with Nursing (Code 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) 117 Dementia (DE) 117 Mental Disorder, excluding learning disability or dementia (MD) 117 Physical Disability (PD) 117 Date of last inspection Care Homes for Older People 1 3 0 5 2 0 0 9 117 117 0 117 Over 65 0 0 117 0 Page 4 of 30 Brief description of the care home Abbey Court is a purpose-built care home, providing nursing and residential care, located within a residential area on the outskirts of Cannock. The home can accommodate up to 117 service users in the following categories; Dementia care (59), Mental disorder, excluding learning disability or dementia (10), Mental disorder, excluding learning disability or dementia- over 65 years of age (25), Old age not falling in any other category (80), Physical disability (58), Physical disability over 65years of age (35). Current scale of charges range from 368 - 650 pounds per week. The home is on two floors and all areas have access via the stairs and/or passenger lift. Within the home there are a total of 13 lounges available. There are four dining rooms and ample facilities in the home including two hairdressing salons. The home has an enclosed garden with a suitable patio area. The registered care manager (RGN) is in charge of the home. First level nurses (both RGN and RMN), and teams of care assistants, provide care. Local GP practices and a pharmacist service the home. Community nurses, health service professionals, and NHS facilities are accessed as and when required. Several local GP practices and a pharmacist service the home. Activities, hobbies and entertainment take place with transport provided as required. Care Homes for Older People Page 5 of 30 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 star. This means that that people who use this service experience good quality outcomes. This unannounced inspection was carried out by two inspectors over one day between 0900 and 1700 hours. The Manager and provider was in the home and both participated in the inspection process. The inspection included the following elements A walk around the building, observation and inspection of care records, discussions with people who use the service, case tracking whereby we select several people who use the service, chat to them and look at their care plans and lifestyle in the home. Discussions with several of the staff members on duty, observation and sampling of other services provided such as catering, and an inspection of the managerial aspects such as staffing issues and training, recruitment and health and safety. We were made welcome in the home and all assistance was given to gain the Care Homes for Older People Page 6 of 30 evidence required for the report. We had dealt with no complaints since the last key inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The management plan to Continue with their Annual Development Plan. Try to improve attendance at relatives meetings. Continue to monitor and update Policies and Procedures. Continue with internal auditing and use the feedback to improve our service. Care Homes for Older People Page 8 of 30 To further develop the Resident led Forum. Several issues identified by the Pharmacy Inspector were raised however the management had actioned these immediately. Recommendations left at this visit were discussed with the management during feedback at the end of the visit. 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 9 of 30 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 30 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 moving into the home do so having had their needs fully assessed and assurances are given that they will be met. The home does not have intermediate care places. Evidence: The AQAA told us Abbey Court is a homely and friendly purpose built nursing home where we encourage residents and their relatives to talk to staff at any time with our open door approach. We have ensured that prospective residents have a choice of bedrooms within the home with many differing bedroom styles and colours. Information received from residents and families helps us to create and update our individualised care plans. Thorough pre-admission assessments we ensure that Abbey Court are able to cater for a prospective residents needs. If we feel that we can not cater for their needs a full explanation is given to both the residents family and the social worker. Prospective residents families are encouraged to visit the home at a time to convenient to them prior to the residents admission. The prospective residents Care Homes for Older People Page 11 of 30 Evidence: family are provided with a brochure of the home, a copy of the Service Users guide which includes our room fees, a copy of terms and conditions and have access to the latest CSCI/CQC inspection report. Prospective residents are also welcome to come in and spend some time in the home before making their decision and are welcome to join us for a meal or for an arranged activity. We like to spend as much time getting to know the prospective resident and their family prior to admission to ensure that their needs can be met and that they have made a positive and informed choice to come and live with us. Pre-admission assessments allow us to create an individualised care plan with all the needs identified ready for their admission. We saw that admissions to the home only take place if the manager is confident that her staff has the skills, ability and qualifications to meet the assessed needs of the prospective new admission. The management team consider the application before an agreement is given to families or social workers. We saw that people considering moving in to the home are given the opportunity to spend time in the home to help them see how the home is run and the facilities and services available. One person that uses the service told us Its very friendly here and the staff make you feel welcome and have a caring approach. Care Homes for Older People Page 12 of 30 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 that use the service have their health, personal and social care needs set out in an individual care plan. They are able to make decisions about their care including the assistance required with medication administration. People living in the home feel that they are treated with respect and their right to privacy is upheld. Evidence: The AQAA told us Abbey Court ensures that the privacy and dignity of our residents is respected at all times whilst striving to maximise independence and promoting autonomy. We do this by ensuing that we knock on a residents door prior to entering and announcing who they are, providing personal telephone lines, having private areas for discussions, retaining their own GP where appropriate, seeing all health professionals within the privacy of their own bedroom, receiving their mail unopened, and being able to choose the sex of the care assistant who provides personal care. All care plans are individually and appropriately written to each residents needs and wishes, all documentation is meaningful, well written and clearly states the current condition of each resident. Each resident is supported to make their own decision and to take the appropriate risks and the home uses individual care planning approach Care Homes for Older People Page 13 of 30 Evidence: which is evaluated at regular intervals. Risk assessments are established within the care plan in relation to tissue viability, falls, the use of bed rails, moving and handling and malnutrition and needs identified from these assessments may result in using specialist equipment as appropriate i.e. pressure relief cushion, full replacement mattresses, sensor pads, bed rails etc. Medication audits are carried out both internally and externally to ensure that our policies and procedures are adhered to with regard to the receipt, recording, handling, administration and disposal of medicines. Through case tracking several people we saw that the people that use the service do receive personal and health care support using a person centered approach. The person centered care could be further extended and this was discussed during the inspection. One relative told us that dignity and respect are considered at all times. She went on to say The care here is excellent and the staff are very respectful to protect my husbands privacy and dignity. Nothing is too much trouble for the staff, they are marvelous. I have been very emotional about seeing my husband in the home but the manager and staff are very compassionate and caring and they help me through difficult times. We saw that the care records had individually recorded personal health care needs including specialist health, nursing and dietary requirements. We saw that the care records identified individual needs and some preferences of people that were using the service. There was evidence that individuals mental capacity being documented and discussed at the time of admission. Family and professional involvement is included in the process as much as possible to enhance the individuals placement. We saw that the delivery of personal care is individual, flexible and person centered with choices being given where there was some basic capacity. Relatives involvement is encouraged to assist with consent should the individual lack mental capacity. We saw that people are supported and helped to be independent and can take responsibility for their personal care needs. Staff were seen to listen to individuals and give choices. People that use the service were seen walking from bedrooms to their choice of lounges or friendship groups. People do have access to health care and remedial services. The health care needs of persons unable to leave the home are managed by visits from local health care Care Homes for Older People Page 14 of 30 Evidence: services. We saw that people do have the aids and equipment they need and these are well maintained to support them and staff in daily living. Staff have access to training in health care matters and are encouraged and given time to attend courses on specialist areas of work. One member of staff spoken to told us I love going on training courses I have done lots, such as dementia care, first aid, nutrition, food hygiene, health and safety, abuse and I have supervision. There was evidence that the managers observe care practices to ensure the staff understand the importance of treating people as individuals with respect and dignity. People that use the service told us My Mother is always kept clean, tidy and comfortable. Her bedroom is light, airy and she has family photographs, favourite ornaments and memorabilia around her. Moms clothes are well laundered and cared for. We looked at how the home was managing the medicines on behalf of the people who were using the service. At the last key inspection on the 13th May 2009 a number of requirements were made in order for the home to improve the way they handled and administered medicines to the people who were using the service. We found at this inspection that some of the requirements had been met and as a consequence the management of medicines had improved in a number of areas. We looked at a sample of administration records for a number of people who were using the service. We found a number of anomalies when comparing these records with the medicines present in the home. On the whole we found that the receipt of medicines coming into the home was being recorded but when looking at one of the chosen sample of people the accuracy of this recording was brought into question. We found that the home did not have an accurate system for recording the disposal of medicines which had been refused and therefore some medicines could not be accounted for. We found that when medicines were not administered the staff were using the generic abbreviation O to identify this on the administration records. Unfortunately the staff were not defining this abbreviation and as a consequence we were unable to establish why the medicine had not been administered. We found that where medicines had been prescribed with a variable dose the records did not always indicate what quantity had been administered. We found with some analgesic tablets that there were more tablets present than the records showed. We found that 112 tablets had been received into the home and 78 of those had been administered. We Care Homes for Older People Page 15 of 30 Evidence: therefore expected to find 34 tablets remaining but we found 48 tablets instead. The reason for the anomaly could not be established but this could indicate that there was a supply of the tablets that had been used from the previous month but had not been accounted for in the records or that the nursing staff were signing the administration records but not actually administering the tablets. We also found the opposite with some sleeping tablets as some of the tablets could not be accounted for. We found that 56 tablets had been received by the home and 41 tablets had been administered. We expected to find 15 tablets left but we only found 12 tablets. We also found another anomaly with some more sleeping tablets. We found that 42 tablets had been received into the home and 14 tablets had been administered until the administration record showed that the tablets had not been administered for the three nights prior to the inspection because they were out of stock. We found a box of tablets that had 28 tablets dispensed into it and the nursing staff thought that because it had not been packed into the Monitored Dosage System the night nursing staff could not find it and assumed it was out of stock. Taking into account this explanation we therefore expected to find 28 tablets still in this box however we found only 22 tablets. The home was not able to provide a satisfactory explanation to these findings. After conveying these findings to the management team of the home the team took the immediate decision to introduce a system of recording the balance of each medicine after each administration round. We found that the home had improved the information about medicines in the care plans. We found information available to assist staff in administering when required medicines. We found that none of the people using the service at the time of the inspection were self administering their medicines. We also found that none of the people using the service required medicines to be disguised in drink or food before administration could take place. We found that all of the nursing staff had been assessed for their competency to handle and administer medicines safely and accurately. The home had found that the all of the nursing staff were competent to handle and administer medicines. However in light of what we found during the audit of the medicines the home need to review its assessment procedures. We found that the Manager was auditing the medicines and the associate records on a monthly basis. In order to reduce the anomalies found with the records and the administration of medicines it was recommended that these audits are done on a more frequent basis. The results of these audits should also be used to assist with the assessment of each individual nurse. We found that the carers who were administering medicated creams had all attended a course on administering medicines. We found that none of the carers had been assessed for their competency Care Homes for Older People Page 16 of 30 Evidence: to administer these medicated cream safely and in accordance with the prescribers instructions. We found that all of the Controlled Drugs cabinets had been secured to the wall correctly and therefore Controlled Drugs held within the home were being stored in accordance with the Misuse of Drugs (Safe Custody) Regulations. The home was also now recording the receipt administration and disposal of Temazepam in the Controlled Drugs register. We found that staff were monitoring the maximum room temperature of the medication rooms and the maximum temperature had not exceeded 25 degrees Celsius. We found that the maximum and minimum temperatures of the fridges that were being used to store medicines were being measured and recorded on a daily basis. On the whole we found that the fridges were being maintained within the expected temperature range. We found that medicated creams and ointments were now being stored securely in the medication rooms and the record of their administration had improved. Care Homes for Older People Page 17 of 30 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. People living in the home find that their lifestyles match their expectations, they maintain contact with family and friends and have choice and control over their life. People receive a wholesome, appealing balanced diet in pleasing surroundings at a time convenient to them. Evidence: The AQAA told us At Abbey Court we ensure that the daily lives and social activities of our residents are dictated by the wishes and needs of the residents. Special occasions such as Christmas, Halloween, Valentines Day, New Year, Easter, May Day etc are celebrated with in house entertainment, fetes etc. We are very fortunate to be supported by our local churches, St Johns Church of England visit the third Thursday of the month to bring Holy Communion, they also visit the bed bound residents. Our Lady of Lourdes Catholic church visit on the second Thursday in the month and the local Pentecostal church regularly visit once a month but not on a set day. We have recently been provided with a Bible for each bedroom by the Gideons Society, these were provided in larger print too. We are currently arranging for the Methodist church to visit as well. We have received regular entertainment from our local Primary and Secondary schools throughout the past year, from performing the Nativity to singing and playing musical instruments. Visitors are welcome at anytime with our open Care Homes for Older People Page 18 of 30 Evidence: visiting policy, they have the choice of having a meal with their relatives. Families are also encouraged where possible to take their relatives out on special occasions and we ensure that we make a fuss of residents when it is their birthday with a cake etc. People that use the service told us There is a good variety of meals and staff are respectful of my needs and nothing is too much trouble. It would be lovely if more music was played, reminiscence songs and visual aids used. Although the television is on the residents dont appear to watch it. One person told us The meals are lovely and I like it when people come in and sing. We observed the routines to be flexible allowing people get up and go to bed when wished. The staff told us that people make it clear when they want to go to bed. People that use the service can sit where they wish, able to go to their bedrooms whenever they wish, and have a wide variety and choice of food. We observed people moving between lounges and walking in corridors. The home has a plan for activities which was displayed but the font was not visually easy to read. The plan the following events, arts and crafts, games, trips out, entertainment coming in, hair dresser. We observed a group of people in the hairdressers which had a very social atmosphere with staff chatting with people and the music was on radio. We saw that the home had regular visitors to the service which were in and out all day. Several people go out with relatives and some go out shopping with staff and on day trips of which four are organised in July. The service encourages groups to visit to provide entertainment including schools and voluntary groups. We observed the lunch time meal being served on each unit. The individuals were seen really enjoying their choice of meal. Second helping were also offered and enjoyed by a few people. The staff offer a choice of meals and drink were served. People that use the service told us that the meals were always good. One lady told us I always enjoy my food here, the cook is marvellous. If I did not like my choice of meal the staff would kindly change it for me. Staff offered discreet support for less independant people, sitting with the individual and using assisted lipped plates to avoid spillages. We identified that the staff need to develop more comprehensive social care plans and information about individuals likes and dislikes, particularly for those with dementia care needs. Care Homes for Older People Page 19 of 30 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. People that use the service are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: The AQAA told us All staff at Abbey Court are vetted prior to the commencing their employment, this includes an enhanced CRB check (Criminal Records Bureau) POVA (Protection of Vulnerable Adults) and a minimum of two references, including at least one from their most recent employer. Staff receive safeguarding training on induction and continuous updates throughout their employment. Residents are protected throughout from any form of abuse or neglect of any kind. The home has a clear and accessible complaints procedure, and all residents, staff and visitors are informed of the complaints procedure and would be fully supported by staff and management alike in making their complaint. The Safeguarding of Vulnerable Adults Policy and Procedure is available at the reception desk and at each Nurses Station. In addition at the reception desk there is a copy of the No Secrets documentation along with details of local Advocacy Services and information on the Mental Capacity Act and Deprivation of Liberty Safeguards. We also have a range of advice booklets from Age Concern to provide information on subjects from Choosing a Care Home through to guidance surrounding funding care and assistance and guidance to planning funeral arrangements. We looked at the homes Complaints Procedure that was displayed in the reception Care Homes for Older People Page 20 of 30 Evidence: hallway and contained in the Service Users Guide and Statement of Purpose. We saw that the home had a complaints folder in place that contained the complaint and the response to complainant. We saw that the complaints procedure is available to all people using the service. We talked to two members of staff who told us they knew how to make a complaint, and how to refer complaints or concerns that people using the service may have and who to refer them to. We talked to several people using the service who told us they knew who to talk to if they were unhappy about something. We saw the records of four staff employed that evidenced to us that they had received training in Safeguarding, Protection of Vulnerable Adults and Abuse. The training matrix which is to be completed, identified that other staff had completed this training. We saw policies and procedures in place for managing abuse. We talked to staff who were able to identify areas of abuse. We were told that all people using the service could have a personal allowance file that is managed by admin staff at the home. Some people manage their own finances. There is a full transaction history of money coming in and out. Strategy meetings had been held to discuss individual safeguarding alerts. Social Services who lead these meetings informed us that they have been well managed by the home and families have been involved. Care Homes for Older People Page 21 of 30 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 that use the service live in a safe, well maintained environment that is clean, pleasant and hygienic. Evidence: The AQAA told us Abbey Court ensures that the environment is well maintained and offers the residents a homely place in which to live. The home is maintained appropriately to reduce the risk of infection and cross infection. The home continues to provide infection control training for all staff so that they are aware of the importance of prevention. The home is equipped with a well equipped laundry with a separate entrance and exit for our clean and dirty areas. Each Resident has their own individual labeled box for their clothing and two mesh laundry bag for their underwear and socks. These are then distributed in the individual boxes to prevent mistakes in the delivery of the residents laundry. The home has a nurse call system with an accessible alarm facility in every room, this is connected to the computer in order for the management to assess and review its usage. The home complies with the requirements of the local fire service and has been carefully designed with separate fire zones with electro magnetic doors. The toilet and bathroom facilities are available to meet the needs of the resident as set out in the National Minimum Standards, these have been redecorated to incorporate seaside/boating themes. The home provides all en-suite bedrooms which are considerably larger than specified in the NMS. All the bedrooms are tastefully decorated with soft furnishings, and provide the resident with Care Homes for Older People Page 22 of 30 Evidence: a choice of bedroom style and colour. We encourage all new residents to make their bedrooms personalised by bringing in personal items from home. Each bedroom has a telephone point and the residents has the choice to have this connected to BT. Each bedroom is centrally heated with controls in each residents bedroom. People that use the service told us Mums room is always clean. We saw that the communal rooms, bedrooms and corridors were all tidy and very well presented. Bedrooms were personalized and comfortable and the dining rooms were welcoming. There were no malodours at all; it was a credit to the staff and the domestics. There had been no infectious outbreaks at the home in recent months and no barrier nursing was being delivered at the time of the inspection. We saw evidence that staff were trained in infection control procedures and had a good understanding with regard to the use of protective clothing and the cross of infection. Care Homes for Older People Page 23 of 30 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. People that use the service have their needs met and are kept safe by the number and skill mix of staff. The homes recruitment policy and practices protect the people living in the home. The staff are trained and competent to do their jobs. Evidence: The AQAA told us We recruit in a fair and open way ensuring we employ the right people with the right attitude who have a commitment to improving the lives of our residents. We ensure that our staff are not only appropriately trained and selected but also that they feel valued and, as a result, we have a low staff turnover and this provides continuity of care to our residents. The home ensures that all staff operate in a manner which promotes liberty, we enable residents to feel safe whilst encouraging independence. Staffing the home is dependant upon the assessed needs of our residents and the home is staffed in accordance to the assessed needs of our residents. We encourage our staff to engage in training and development and most of our staff have now achieved NVQ level 2 or are in the process of studying towards their NVQ level 2. The staff at Abbey Court are flexible and we have reliable bank staff which means we are able to avoid using agency staff and this provides continuity to our residents. The people that use the service told us The staff are supportive to residents and families. The staff are very nice and work hard, I like living here. Care Homes for Older People Page 24 of 30 Evidence: Staff working at the home told us The home look after their staff and offers them lots of training and NVQ qualifications. The staff always try to meet the needs of the residents and their families. The residents have a good choice of activities and food preferences are met. We discussed the staff rota with the manager. We saw that the staffing to person ratio appeared satisfactory. We saw records that told us 80 of staff are trained to National Vocational Qualification Levels 2 and 3. The homes Manager and Deputy Manager both have the registered Managers Award. We were told that the home very rarely uses agency staff as any shortages are covered by the existing staff or bank staff. We were told by the Manager that the home recruits staff via the recommendations of existing staff, the Job Centre or advertisements in the local newspaper. We looked at the files of four members of staff employed. Files contained two references, Criminal Records Bureau and Protection of Vulnerable Adults checks. This means that staff had been appropriately recruited. We saw that staff had received a statement of their terms and conditions and job description. We were told that the home does not use volunteers. We saw that there is a staff training programme/plan in place for the development of staff. We saw in staff files records of induction and individual training records. There is also a training matrix which when completed will give an overall picture of training completed and training due. Care Homes for Older People Page 25 of 30 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. People live in a home which is well managed by a person of good character. The home is run in the best interests of the people living in it and their financial interests are safeguarded. The health, safety and welfare of people who use the service and the staff are promoted and protected. Evidence: The AQAA told us The home is well structured and closely monitored with the Directors frequently visiting at least three days per week. The two directors visit independently and always tour the building and speak with each and every resident, visitor and member of staff. The company engaged an Operational Manager who works within the group and she has presently been in post for the past twenty months, she has a wealth of experience in the management of care homes and this has provided extra managerial support. The Registered Care Home Manager has been in post for eight years, and has ten years experience as a care manager and holds the Registered Managers Award qualification in management of care. The deputy manager is an experienced Registered Mental Nurse who has recently achieved her Level 4 in Care Homes for Older People Page 26 of 30 Evidence: Leadership and Management. The home is financially viable and the directors use suitable accountancy and budgetary procedures at all times. Our employers/public liability insurance certificates are up to date and prominently displayed in main reception. We send out regular themed Quality Assurance Questionnaires on various themes and audit the responses we receive and make any necessary changes to ensure that we are fully meeting the ever changing needs of residents. All staff receive formal Supervision at least six times a year. The management team closely monitors the practices in the home and there is a robust quality assurance system with action plans developed and reviewed as required. The Home maintains robust systems and records of all finances and property. These are audited on a regular basis. We saw evidence that the home is well maintained and records are kept. The manager has completed necessary fire risk assessments. The AQAA completed by the manager confirmed that fire safety is checked and regular fire drills and training provided for all staff. The staff complete the Health and Safety training as well as additional training, where appropriate. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 13 (2) The registered person 24/06/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The records of the receipt, administration and disposal of all medicines for people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Care Homes for Older People Page 28 of 30 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 8 Develop more person centered plans so that staff have all the necessary information to provide care in the way people need and that their preferences are always promoted. The recording of the receipt, administration and disposal of Temazepam tablets are recorded in a bound book where the pages are numbered To consider further areas for developing activities for people with dementia taking into account information from their Life Histories and also to consider the use of sensory equipment. This could increase peoples opportunities for interaction and stimulation. 2 9 3 12 Care Homes for Older People Page 29 of 30 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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