Care Home: Abbey Dean

What the care home does well The home has an assessment process which enables the manager to decide whether Abbey Dean can meet the needs of the individual. The ones we saw on this occasion were completed and were used to inform the care plan. The home has care plans which describe the needs of the individual and what they are able to do independently. The plans describe the support staff have to give. When we spoke with people using the service they told us they were happy with the activities that are available for them. They enjoy the newsletter about the home. Daily routines in the home were flexible and people who use the service being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. A variety of social and leisure activities have been planned and residents have a choice of whether to participate in these or not. People who live at the home were generally positive about the food that the home provided and the condition of the accommodation that they occupied. The home is regularly maintained and is comfortable with pleasant furnishing. Staff have undertaken training in mandatory areas and in caring for people with confusion and management of medication. We saw that new staff had been recruited and that the home had carried out checks to protect people who use the service. New staff have begun induction training in working at the home. Staff have received updated training in many areas such as moving and handling. People who use the service are consulted about the home and what they would like whilst they live there. Whilst it was seen that the home is doing well in the areas where action was required for improvement, the areas that have improved are listed in the following section of this report. What has improved since the last inspection? The AQAA said: "We have made substantial improvements to our management system, including our risk assessment and care planing process and our admission procedure, and our recruitment procedure and process. We have completely re written our policies and procedures. We have improved our training regime, we have an annual training programme to enhance the quality of care delivered. We have developed a visual system for annual and regular maintenance and service reviews and checks. We have redecorated 4 of our bedrooms and refurbished as needed. We have completed our double glazing programme and replaced the last 4 of the old sash windows sympathetically. We have purchased new dining room furniture. We have commenced residents meetings. We have initiated a newsletter. We have developed a system for user surveys and the results once evaluated are published in the newsletter. We have improved our communication within the home, we now have an additional communications book to work alongside our daily diary, together with a maintenance book to highlight problems such as light bulbs which need replacing and any other problems or areas which need attention. We have changed our menu to meet residents preferences, taking into account nutritional needs, whilst ensuring wholesome nutritious meals are cooked daily. This is a 4 week rotating menu on view in the dining room". The following are areas where action was required and these requirements have been met. We saw evidence that the information in the AQAA was substantiated. The home carries out assessment visits to prospective residents to ensure that they can meet the needs of the individual. The home has care plans which describe the needs of the individual and what they are able to do independently. The plans describe the support staff have to give. The storage and administration of medication has improved with all staff having undertaken training in medication administration. The home`s current recruitment process now protects people who use the service. Staff have undertaken training in mandatory areas and training that helps support individual needs. What the care home could do better: Whilst we have been told that the home plans to imbed the improvements they have made to the service offered at the home, this improvement must be sustained and further planning to improve the service and its future undertaken. Key inspection report Care homes for older people Name: Address: Abbey Dean 102 Barnham Road Barnham Chichester West Sussex PO22 0EW     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: Val Sevier     Date: 0 3 0 8 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 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) 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 30 Information about the care home Name of care home: Address: Abbey Dean 102 Barnham Road Barnham Chichester West Sussex PO22 0EW 01243554535 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr David Geoffrey Dean, Mrs Laramie Dean care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Abbey Dean is registered to provide personal care for up to fourteen people over the age of sixty-five years (category OP). The building is semi-detached and the accommodation is provided on the ground and first floor. The accommodation is single rooms that have en-suite facilities with a toilet and hand basin. A passenger lift is provided to the first floor. There is a lounge, conservatory and dining room on the ground floor. There are well kept gardens with lawns and walkways that are accessible. Mr and Mrs Dean own Abbey Dean. Mrs Dean is the registered manager responsible for Care Homes for Older People Page 4 of 30 Over 65 14 0 0 9 0 2 2 0 0 9 Brief description of the care home the day-to-day management of the establishment. The fees for the home at the time of the visit were #495 per week. 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 2 star. This means the people that use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 3rd August 2009 between the hours of 09:50 and 2:00pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in February and May2009. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 30 meeting the needs of people who live at the home. We met with the senior staff member on duty, two staff, and there were three people who use the service involved in the inspection visit. We looked at three pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. The registered manager and provider Mrs Dean was not available on the day of the visit, we were assisted with our visit by the staff. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had ten surveys returned from people who use the service, eight staff surveys and two professionals, a GP and a ward manager at a local hospital. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The AQAA said: We have made substantial improvements to our management system, including our risk assessment and care planing process and our admission procedure, and our recruitment procedure and process. We have completely re written our policies and procedures. We have improved our training regime, we have an annual training programme to enhance the quality of care delivered. We have developed a visual system for annual and regular maintenance and service reviews and checks. We have redecorated 4 of our bedrooms and refurbished as needed. We have completed our double glazing programme and replaced the last 4 of the old sash windows sympathetically. We have purchased new dining room furniture. We have commenced residents meetings. We have initiated a newsletter. We have developed a system for user surveys and the results once evaluated are published in the newsletter. We have improved our communication within the home, we now have an additional Care Homes for Older People Page 8 of 30 communications book to work alongside our daily diary, together with a maintenance book to highlight problems such as light bulbs which need replacing and any other problems or areas which need attention. We have changed our menu to meet residents preferences, taking into account nutritional needs, whilst ensuring wholesome nutritious meals are cooked daily. This is a 4 week rotating menu on view in the dining room. The following are areas where action was required and these requirements have been met. We saw evidence that the information in the AQAA was substantiated. The home carries out assessment visits to prospective residents to ensure that they can meet the needs of the individual. The home has care plans which describe the needs of the individual and what they are able to do independently. The plans describe the support staff have to give. The storage and administration of medication has improved with all staff having undertaken training in medication administration. The homes current recruitment process now protects people who use the service. Staff have undertaken training in mandatory areas and training that helps support individual needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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 that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said: We have a new service user guide setting out clearly the statement of purpose, the facilities we provide, the terms and conditions, complaints and fire procedures, the accomodation, other service users views, information about staff and their experience and training. We have included photos of the rooms and grounds. All service users have been given a copy on their arrival. An audio CD for those with visual impairment, is available on request. Service user guides are also available in the entrance hall for any visitors to the home. Service user guides are sent out to any prospective new residents, they are cordially invited to afternoon tea, morning coffee or lunch which ever is most convenient for them. A member of staff ideally their prospective key worker, would be available to make them welcome, Care Homes for Older People Page 11 of 30 Evidence: answer questions and introduce them to other residents and staff. Each new service user has their own personalised service users guide, this includes a floor plan and the location and number of their room. Each prospective new service user will have a home or hospital assessment, based on the Roper activities of living, in order to ensure we are aware of their needs, values and beliefs and can determine if the home is able to meet their individual needs. A letter of confirmation stating we are able to meet those needs is sent out to the prospective resident Following the assessment risk assessments will be made and clear care plans developed to manage needs safely and effectively with respect and dignity. Residents and their families and advocates, play an active part in the care planning process, advice from other health professionals is sought should it be indicated. Service users admitted as an emergency, which is not recommended are assessed on arrival, given information regarding key aspects of the home. They are given a service users guide. There have been three new admissions to the home since we last visited. We saw that there was information on individual needs based on their present and past medical history for example, history of falls. The assessment offered choices and space for individual issues. For example,needs assistance to get out of the chair with one person, needs encouragement as confidence lost due to falls. There were risk assessments, information on mood, sleep patterns, pain and physical health, current care providers and equipment that may be needed. For example we saw that one individual had had an assessment from an occupational therapist and they had provided a walking frame, a pressure relieving mattress and cushion. We saw copies of letters to people confirming that the home could meet their assessed needs and asking them if they still required the placement. In our surveys we ask what the service does well, a ward manager commented in this section that the home carries out assessment of patients prior to discharge. All surveys returned from people that use the service indicated that they had received enough information to help them decide that Abbey Dean was the right home for them. 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. The care plans detail the needs of the individual and support staff are to give. The medication records and administration within the home are carried out in a safe manner and protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that: Each service user has an individual and comprehensive assessment prior to admission, from which a plan of care is generated. Each service user has personalised risk assessments and care plans developed to minimise those risks and meet their needs. Staff have been trained in documentation and care planning and therefore are ideally placed to review the care monthly or more if needed and update the care plans, ensuring there is clear guidance as to how to provide appropriate care to meet individual needs and the action to take to minimise any risks identified. Professional advice is sought in such areas as nutrition, pressure sore prevention, continence and mental capacity, should their risk assessment indicate this is needed. Care plans concerning personal care are devised specifically for the Care Homes for Older People Page 13 of 30 Evidence: individual with their full collaboration and input, thus ensuring the residents choice, dignity, privacy and independence is respected. Advice and support from other health professional is sought should risk assessment and care plans dictate. Care plans are assessed at least monthly, as a result we are able to identify any potential health needs early and involve the multidisciplinary team as indicated. All care plans and medication records have a dated photo attached to them. End of life care plans are drawn up when needed and are service user specific, in order to ensure clarity. These end of life care plans have been devised with input from the district nurse team, to facilitate partnership working. We have purchased a new medicine trolley and a new controlled drug cupboard we have overhauled our medication system rewritten our drugs policy and procedure to meet our needs. We have thorough and appropriate risk assessments and care plans, for self medication, discussed, agreed and signed by service users. We have care plans for when needed medications. All care staff involved with medication have undertaken appropriate training. We perform a monthly medicine audit. We work together with our local pharmacist. In how we have improved in the last 12 months the AQAA said: We have completely reviewed our risk assessment and care planning systems. They are person centred and drawn up with the full collaboration of the resident and or family or advocate. Each risk assessment and individual care plan, particularly in areas such as, continence, nutrition, pressure sore relief and mental health, gives clear guidance to carers on how to meet needs effectively and minimise risks identified. At least monthly assessments are carried out by key workers and supported by other care staff, to ensure all risks are minimised and care continues to be appropriate and effective to meet needs. This provides the evidence to enable us to involve the appropriate health professionals, should it be necessary for their help and support. We have completely rewritten all our policies and procedures to ensure they are up to date and in line with legislation. We have improved our training systems. We now have a clear visual annual planner. This is easily accessed, wall mounted, depicting month by month programme of all training, both mandatory, external and internal. This enhances the care our staff deliver and ensures they are skilled and knowledgeable in all aspects of care. We have introduced new nutritional screening methods using the MUST tool. We have introduced a pressure sore risk assessment. To supplement the existing care we invite a I.M.C.A. (independent mental capacity) advocate to provide advocacy and clarity if we are unsure about an individuals capacity to make decisions about everyday care and to ensure we fully comprehend their needs and can provide appropriate care. The member of staff helping us on the day told us that three people had moved to the home since our last visit. We looked at their care plans and all documents associated Care Homes for Older People Page 14 of 30 Evidence: with their care and support. There was a life history in each care plan seen. This gave information about their life, occupation, family and interests. We saw that care plans had been reviewed monthly, in all cases except one where we saw that a care plan regarding pressure care had not been updated. For one individual the care plans documented their strengths and abilities and what staff needed to do to support them. The person has expressed to be self caring wherever possible and for as long as possible health permitting and has given preferences for bath times and days, when they want to get up and go to bed and foods. We saw that they were able to care for themselves easily for the top half of their body for example getting washed and dressed, however they needed help with their lower half and assistance in walking. We saw risk assessments had been put in place with information on how staff could lessen those risks for example manual handling and falls; making sure equipment was secure safe and usable and that the environment was clutter free and supporting with using lift as doesnt like to use lift alone. We saw that there were also records of weight and wound assessments. We saw that the district nursing team was supporting the home with care of pressure areas the individual had when they moved to the home. We found in the daily notes that the nurse had redressed leg we asked the member of staff about this as we could not see anything else about this in the care plan. The member of staff helping us said that this had been put in error on this care plan. We saw on the second individuals care plan that they also expressed to be self caring wherever possible and for as long as possible health permitting and had given preferences for bath times and days, when they want to get up and go to bed and foods. We saw preferences regarding the night time for example occasional night checks, light off, likes door open. We saw that the nutritional assessment tool had been done and this indicated that the person was at risk of malnutrition due to frailty, ileostomy, with weight loss whilst in hospital recently. We saw that the dietitian was supporting the home with advice for the individual and monitoring was in place. There was information about diet for example, small frequent meals, cream to be added to cereals, porridge and desserts, milky drinks between meals and a snack last thing at night. For the third person we saw that they required use of oxygen via a converter we saw that the person managed this for themselves, there was a care plan advising staff of the support they could give and instructions of what to do should there be a power cut. Due to poor eyesight they are reluctant to join in group activities however they have been enabled to have talking books and they keep in touch with their friends. We saw that their care plans were quite specific in the support the individual needed, likes door closed at night with occasional might checks, dont move things around without telling person. We saw that this individual had red pressure areas, this Care Homes for Older People Page 15 of 30 Evidence: varied between a written evaluation of size and grading to three breaks. The instructions for care staff were to cream area, and that varied from between twice daily and four times a day and was altered each day by different people. We saw that the district nurse had been contacted about pressure areas which had started in hospital. Although there was communication seen between the home and the district nurse about pressure relieving aids which have been received by the home, we could not see any evidence that they had visited, assessed and offered support about care for pressure areas. We looked at the medication storage and administration records. There had been concerns about medication and its administration following our last visit we saw that the home had actioned our requirements. The medication trolley can be kept attached to the wall downstairs or upstairs in the staff sleeping in room. The home has Oramorph stored as a controlled medication and this was kept locked in a small safe attached to the wall in the staff sleeping in room. We saw that staff could read guidelines and policies on medication administration, errors, household remedies, risk assessments for people who wanted to self medicate, prescription terms, and generic abbreviations. We saw that the medication records had been kept by staff there were no gaps. Medication had been booked into the home and there was a record of the amount the home had received. We saw that there were care plans for individuals where medication was prescribed to be given as required. We saw where individuals had been assessed as being able to administer their own medications for example lotions and inhalers. All surveys returned by staff indicated that they are given up to date information about the support they are to give people that live at the home. I think the home is run well, all areas of paper work have improved, all staff are confident in how to fill in care plans, we all understand why it needs to be done correctly. The home cares well for all residents with medical physical and social needs. Care Homes for Older People Page 16 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 who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: We offer a varied rolling monthly entertainment schedule, evaluated by residents and entertainers, for participation and suitability. The activities include classical music hour, several different entertainers offering varying levels of participation. We have recently introduced pamper sessions whereby residents can have hand massage and one to one reminiscence. Residents told us they would like to have more activities in the morning as they like to nap in the afternoon. As a result of this we have arranged for more morning entertainment to supplement our activities programme to offer more choice. We have monthly communion and are happy to take residents to a church of their denomination. We offer fortnightly minibus rides to tea rooms, garden centres or just to see the sea or the country We have a new cook and assistant cook, who offer a tasty, nutritional and varied menu. We have a rolling 4 week menu, on display for all residents and their families to see. There is always a choice for every meal. These menus have been devised in Care Homes for Older People Page 17 of 30 Evidence: collaboration with the residents according to their likes, dislikes and nutritional status. Residents may have any of their meals in their room but they are encouraged to join the other service users for lunch to make it a social occasion. Relatives and family are very welcome to have lunch or any other meal or beverage. Lunch can be arranged by prior arrangement. Squash is always freely available in the lounge. Specialist diets and specially prepared foods are easily and discreetly catered for and we endeavour to make them look attractive. Service users may entertain friends and family in their own room, the lounge or in the privacy of the conservatory. Service users are encouraged to bring their own possessions to personalise their rooms Residents are invited to join and participate in the regular residents meetings, to empower them as part of the decision making process as to how the home is run. We have a rolling 3 month programme of 3 user surveys for residents covering all aspects of daily life and social activities, these are audited, actioned and published in the newsletter. We saw that the home has a menu which was on display in the dining room; we saw that there is one for each week over a month. This is changed daily and people who use the service asked the inspector what was for lunch the next day. The meal on the day of the visit was home made sausage and stuffing plait, boiled potatoes, broccoli and sweet corn or tuna salad with egg custard and or fresh fruit for dessert. The menu applies to lunch time and staff ask individuals what they would like for supper. We saw in the diary a record of the meals served and saw that there were several choices prepared for example: chicken salad, pizza and salad, cheese and biscuits and egg and bacon. We also saw the breakfast list where breakfast for individuals range between toast, grapefruit, squash, Ry-vita, cereals, bananas, cranberry and prunes. We looked at the rota while we were at the home and spoke with staff and there were two care staff on duty on the day of the visit from 2pm. They were responsible for care, the management of the home and preparing, cooking and serving 14 suppers. We saw on two care plans that individuals had bath days this included weekends. Staff said that this could be changed and we saw where an individual had requested a second bath each week. Care Homes for Older People Page 18 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 who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: There is a clear complaints procedure on display in the front hall, and a complaints book where a complaint may be logged and the action and outcome is also recorded. The complaints procedure is contained within the service user guide of which all residents are given a copy. A copy of this is displayed in the hall. The service user guide is also available on CD-ROM for those with any visual impairment. We have commenced regular residents meetings whereby residents are empowered to assist in the decision making within the home. These meetings are minuted. We have improved our systems for monitoring our service and send out quarterly user surveys where residents are asked to give their opinion on all aspects of their care and the service in general. They are also invited to make suggestions and put forward ideas for improvement. We now have an improved, solid recruitment procedure and only employ staff once relevant checks have been made and references taken up. All new care staff undergo Care Homes for Older People Page 19 of 30 Evidence: a TOPSS induction within the 3 months of being employed. Staff have undergone safeguarding vulnerable adults protection training and the home has a copy of the Sussex Multi Agency Policy and Procedure for Safeguarding Vulnerable Adults. There is a rolling staff training programme preventing and identifying elderly abuse. Some staff have recently attended external roadshows facilitated by West Sussex, dealing with protecting vulnerable adults how to identify problems and how to report and alert a suspected abuse. This information was been cascaded down at the May staff meeting and information regarding this offered to relatives. Many staff have attended external training on coping with confusion and aggression, Deprivation of Liberty Safeguards, Mental Capacity Act. Where a service user lacks capacity an external advocate is accessed. Residents all have a lockable facility in their own room. Personal details regarding residents are locked in a cupboard in line with data protection. The home has complaints procedure, which are outlined in the Statement of Purpose and Service User Guide and on display in a number of places around the home including on a notice board above the visitors signing in book. It includes the timescale of response and the address of CQC. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. The manager has attended safeguarding update and attended a session on the Mental Capacity Act in April 2009. We saw that the manager had purchased information relating to this Act and guidance on Deprivation of Liberty. We saw that some staff at the home have had training in safeguarding in July and that training is undertaken with new staff as part of their induction. Care Homes for Older People Page 20 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 who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. Evidence: The AQAA for the home said: Abbey Dean offers a homely environment that is both safe and comfortable and provides a relaxing atmosphere for our residents. Abbey Dean has a rolling programme of maintenance, internal areas are well maintained in good repair and decorated. We have recently replaced the 4 remaining old sash, single glazed windows, sympathetically with the original building. The garden is well maintained with areas of sun and shade and a summer house for shelter. There is a circular path designed for service users to walk safely and be observed easily. There is seating areas for residents to sit out in the garden in warmer weather. Residents rooms comply with standards, all have en-suite bathrooms, call bells, telephone points and flat screen televisions are being provided as each room is redecorated. The furnishings are clean and in good order. Three rooms have new soft furnishings and three new beds. Four bedrooms have been redecorated and this programme of redecoration continues before any new service user moves in. As part of our new improved quality assurance system bedrooms and communal areas are monitored each month to assess decoration, cleanliness, furnishings, carpet and safety. New service users are encouraged to personalise their rooms with furniture and pictures. All rooms have individual thermostats fitted to the radiators and radiator guards. Care Homes for Older People Page 21 of 30 Evidence: Communal areas are well lit, well decorated and clean, there are separate areas for service users to entertain family and friends. We are aware that there will be occasions when residents may become unwell and could have an incidence of incontinence for example causing an odour at that time. These incidents will be dealt with sensitively, discretely and promptly. We fully understand the importance of keeping the home odour free and have preventative measures in place as far as is practicable. Any specialist equipment can be accommodated and is available from district nursing services. We have a new hoist available. Staff are trained to use this should the need arise. We have developed a new and comprehensive control of infection policy, ensuring all staff recognise the risks of cross infection, how to minimise those risks and how to deal with soiled laundry spillages, recognising the colour codes for cloths, mops and buckets and which areas they should be used in, and the importance of hand washing as the single most important activity to reduce infection. All staff have undertaken control of infection training in March 2009. The domestics have an audited rolling programme of cleaning they and staff are aware of the importance of odour control. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. We did see that the window on the first floor landing opened up fully. We did see in the communal bathrooms that there were cleaning fluids left out, several bars of soap one had hair on it, a pair of pointed rusty scissors, a rusty tin of shaving foam, various bottles of shampoo and bubble bath, two grubby tubes of toothpaste, a tooth brush and a bottle of anti dandruff shampoo with an expiry date of May 2009. Individuals commented to us that they were happy with their accommodation those that had them liked having en-suite facilities. They described small pieces of furniture that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. Laundry facilities are sited away from areas where food is prepared and stored. Care Homes for Older People Page 22 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. Current recruitment practices at the home help to protect the people who use the service. Staff have received all the mandatory training that is expected each year, and training to help them meet specific individual needs. Evidence: The AQAA for the home said: We have 50 of our staff NVQ 2 trained we have a further 2 undertaking NVQ 3, as well as the home owner we have a staff member who is a trained RN. All new staff have been subjected to a thorough and robust recruitment procedure. All are CRB checked POVA checked and 2 references are taken up. All undertake a supervised shift and all undertake a comprehensive TOPSS induction programme to complete in 3 months. All staff have regular supervision sessions whereby any support or additional training needs can be identified and sourced. All staff have regular fire training updates in line with legislation. We have a very positive approach to training. All staff undergo mandatory training and we have improved our annual training regime. In addition to this we can access further training in various subjects throughout the year through the Care Consortium. We are often above the statutory staffing level, we have a laundress who manages the laundry, enabling carers to do their job effectively We employ staff in sufficient numbers and do NOT use agency staff at all.We have a low staff turn over rate. The staffing structure at the home consists of the owners, one of whom is the Care Homes for Older People Page 23 of 30 Evidence: registered manager, support workers, kitchen staff, and housekeeping. There are two night staff one awake and one asleep. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. On the day of our visit there were two care staff and a cook working until 2:00pm, and we were told one other member of staff looking after the laundry and cleaning in the morning, although we did not see this person. The rotas indicated that the domestics work three days a week for four hours; the laundress also works three days a week. When these staff are not at work the care staff carry out these duties in addition to their care work. Care staff prepare and serve breakfast and supper. One member of staff has been employed to assist with entertainment or offer additional support for four hours on Monday, Wednesday and Friday. Two people have been employed to work at the home recently and we saw that there were two references, there was evidence that a CRB had been received and that a POVA First check had been carried out and they were dated before the employee commenced work at the home. We saw that the individuals had commenced an induction process. Supervised placements take place before the employee has begun work, and after recruitment checks have been returned. All staff information is kept at the home in locked drawer in the managers office. There were concerns following the last visit to the home about training that had not been undertaken by staff. We saw a training plan for staff for the years 2009 to 2010, we could see what staff had done and what was planned. Staff have undertaken medication administration training, food hygiene, fire safety, first aid, infection control and moving and handling. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack with questionnaires on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. Four surveys returned by staff state that there are usually enough staff on to meet individual needs and four surveys indicated that there were always enough staff. Seven surveys from people that use the service indicated that they receive the care they need and staff are always available when they need them, three surveys indicated that they usually receive the support they need and that staff are usually available when they need them Care Homes for Older People Page 24 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. The systems and procedures monitor and maintain the quality of the service provided and which, promote the safety and welfare of those living and working in the home. Evidence: The AQAA for the home said: The manager has a democratic approach to management and has an open door policy. Residents meetings have now commenced in order for the residents to be more involved in the day to day running of the home. User surveys are carried out and audited in order to obtain views from residents and their family and friends as to how the home is performing in all areas. The results are evaluated and published within the new newsletters that are now being distributed. Record keeping in general has been improved with particular regard to data protection. Medication systems have all been reviewed and improved. An audit of the accident book is carried out by the manager on a monthly basis. This is evaluated quarterly in order to highlight any risk areas or times of accidents and put any extra controls in place as necessary. We have reviewed and improved our policies and Care Homes for Older People Page 25 of 30 Evidence: procedures within the home to ensure that they are relevant and up to date with current legislation. The recruitment procedure has been reviewed and improved. Residents monies for their personal allowance is kept safely locked away. A clear record and receipt system is kept. The home owner is dedicated and experienced, both flexible and supportive of staff, prepared to support staff day, night and weekends should this be needed. The manager is on call and can be cont aced by mobile phone for advice and support at any time. All mandatory training is up to date. Many extra external courses have been undertaken by staff particularly in the areas of confusion, protecting vulnerable adults and medicine management. A new annual training regime has been drawn up. Supervision for care staff now incorporates group supervision as well as one to one. The group supervisions have proved very productive as they promote discussion and information sharing. The care planning system has been reviewed and improved. Action plans give staff clear guidelines as to how to meet residents needs and are reviewed monthly to ensure that care is effective and relevant. Risk assessment systems have been reviewed and improved and now give staff clear guidance on what action they should take to minimise any risk. These are reviewed monthly by key workers. The manager Mrs Dean is a nurse although she is not employed as a nurse at the home, which provides personal care. She also has a Masters Degree in Business Studies. She has been managing the service at Abbey Dean since the home opened in 1991. Mrs Dean also works one day a week at the local GP surgery. Mrs Dean was away on the day of our visit. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that the manager has undertaken staff and resident meetings. The residents commented on food, staff, activities and the homes environment. The member of staff assisting us on the day of the visits told us that the home manages weekly personal allowances for five individuals. Due to the manager and administrator being away we were unable to check any records regarding personal monies. The people whose money is looked after by the home were also unable to access their money. The manager informed the commission in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We saw the policies available to staff and that new ones have been introduced as Care Homes for Older People Page 26 of 30 Evidence: necessary for example training and medication. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment has been tested regularly and that staff have received training every six months. Care Homes for Older People Page 27 of 30 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 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 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). 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!