Care Home: Abbey House

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• Applegarth
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What the care home does well People living at Abbey House are supported by staff, many of which are experienced and have attained a qualification in care. Everyone has a care plan which details the care and support each person requires. Staff who provide the care and support access a range of training which enables them to care for people well and promote their rights and safety. We observed staff supporting people with sensitivity and respect, and with consideration to their privacy and dignity, staff we spoke with had a good understanding of the needs of people in their care, and knew about what was important to them such as their family and friends. People we spoke with were complimentary about the attitude and approach of staff and the care they received. Surveys we sent to people who live a Abbey House and their relatives asked them what they thought the home did well, and also asked them if their was anything else they would like to tell us. They wrote:`Most things` `Well looked after` `Good meals` `Kept clean` `Happy with home` The surveys we sent to staff asked them what they thought the service did well. They wrote:`Very good at pallative care and making sure pressure areas do not appear and are dealt with effectively.` `Care for service users needs and provide activities. We take people out and take them shopping.` `I think Abbey House is ran smoothly and well enough to meet clients needs.` `We look after our residents very well they have a very varied diet and we cater for all their needs.` What has improved since the last inspection? A majority of staff have received training in providing care and support to people with Dementia. Information recorded into care plans is more comprehensive and reflects the wishes and views of people living at Abbey House.Consultation with people living at the home and their relatives now includes sending a survey to people to find out their views about the service the home provides. What the care home could do better: Where people require support and care because they have Dementia or suffer memory loss could be improved, by care plans containing greater information and guidance. The well being of people with Dementia could further be promoted by the furnishings and decor of the home being altered to promote well-being and assist with oritentation by the use of different colours and by understanding how patterns affect people with Dementia. The quality assurance process needs to be expanded to ensure that all elements of the home are reviewed to ascertain whether systems including the training staff receive benefits the care and quality of support people living at the home receive. An increase in care staffing levels and additional staffing in specific areas such as activities and laundry would have a significant impact on the quality of lives people at the home receive, by enabling people to have greater access to a range of tailored activities and along with additional opportunities to go on outings, whilst enabling staff to spend quality time with people, talking about things that are important to them. Care plans should include the wishes and expectations of people with regards to activities and recreational interests. The accessibility of information for people living at the home or who are considering moving to the home could be improved, by Abbey House providing information in a more accessible format, which considers the needs of people for whom the service is intended for. Other information needs to be more readily available including the complaints procedure, the outcome of quality assurance processes and the minutes of meetings people living at the home attend. Surveys we sent to people living at Abbey House and staff employed asked them if their was anything the home could do to improve the service they received. They wrote:`It is a very good home, but could put more input in with the residents with games not just sitting around all day.` `Have more staff to help take people out in wheelchairs and to spend more time with lonely people.` Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey House Stokes Drive Leicester LE3 9BR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Linda Clarke     Date: 1 3 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Abbey House Stokes Drive Leicester LE3 9BR 01162312350 01162875186 socis215@leicester.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Leicester City Council care home 33 Number of places (if applicable): Under 65 Over 65 20 20 33 8 10 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: 0 0 0 0 0 Service User Numbers DE(E) or MD(E) No one falling within category DE(E) or MD(E) may be admitted into Abbey House when 20 persons who fall within categories/combined categories DE(E) or MD(E) are already accommodated within the home Service User Numbers PD(E) No one falling within the category PD(E) may be admitted into Abbey House where there are 8 persons of category PD(E) already accommodated within the home Service User Numbers SI(E) No one falling within the category SI(E) may be admitted into Abbey House where there are 10 persons of category SI(E) already accommodated within the home Date of last inspection Care Homes for Older People Page 4 of 33 Brief description of the care home Abbey House Residential Home provides accommodation for up to thirty three older people and is owned by Leicester City Council. The home is situated along a main road in a residential area with car parking space to the front of the home. The home is located approximately a ten-minute bus journey from the city centre. There are shops, pubs, a post office and other local amenities approximately half a mile from the home. Abbey House is a large purpose built property. Accommodation is offered on the ground and first floor, which can be accessed by a passenger lift and stairwells. Bath/shower and toilet facilities are located througout the home. There is a secure garden to the side of the home which is accessible and provides a pleasant environment for people to sit. There are communal facilities and bedrooms all of which are single and without en-suite facilities which are located on both the ground and first floor. All areas of the home are accessible to people using mobility support, aids and adaptations. Information is located on site detailing the range of services offered, which includes the Statement of Purpose and Service User Guide. Abbey House has copies of the Care Quality Commission, (CQC) Inspection Reports, and are available upon request. Information regarding fees is available by contacting the Registered Manager of Abbey House. An individuals financial contribution to care is dependent upon a financial assessment. There are additional individual expenditures such as hairdressing, chiropody, newspapers, magazines and personal items including toiletries and the fee will depend upon the services received. Care Homes for Older People Page 5 of 33 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: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool completed by a representative of the service, reviewing previous Inspection Reports, and looking at any information we have received. The unannounced site visit commenced on the 13th July 2009, and took place between 08:45 and 15:30. The focus of the inspection is based upon the outcomes for people who use the service. Care Homes for Older People Page 6 of 33 The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Abbey House. Four people were chosen and discussions were held with two of them, along with three other people who live at the home and two visitors who were visiting relatives on the day of our site visit. Staff members were spoken with along with the Registered Manager. We also sent surveys to some people who live at Abbey House, and their relatives. Surveys were also sent to health care professionals, and a selection of staff who work at the home to seek their views about Abbey House. Surveys were returned but none were received from health care professionals. What the care home does well: What has improved since the last inspection? A majority of staff have received training in providing care and support to people with Dementia. Information recorded into care plans is more comprehensive and reflects the wishes and views of people living at Abbey House. Care Homes for Older People Page 8 of 33 Consultation with people living at the home and their relatives now includes sending a survey to people to find out their views about the service the home provides. 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 set out 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 33 Care Homes for Older People Page 10 of 33 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 11 of 33 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. Abbey House enables people who require residential care to make an informed decision as to whether the home is appropriate to their needs by providing information about its services and through its assessment and review process. Evidence: We wanted to look at the information provided to people who use the service to find out whether it was detailed and answered all their questions, and to find out how the service passed on the information. We found that the information provided to people is referred to as the Statement of Purpose and Service User Guide, we looked at these documents and found that they were an accurate reflection of the services provided. The accessibility of the documents could be improved by considering their format such as larger print and the inclusion of photographs, given that the home provides care for Older People which includes those with Dementia and a Sensory Impairment. We spoke with some of the people who live at Abbey House and individuals who were Care Homes for Older People Page 12 of 33 Evidence: visiting relatives on the day of our site visit, and we found that their were mixed comments as to whether they had received information about the home prior to their moving in. Surveys that were returned to us, which we sent out to some people living at the home to help us find out about the views of people who use the service and their relatives told us that they had received information which enabled them to make an informed choice as to whether Abbey House was the appropriate residential home for them. The Registered Manager said in some instances a copy of the information is kept in the bedrooms of the home. The Registered Manager in the information provided to us prior to our site visit told us that relatives are asked to provide additional information when someone moves into the home, which includes information about the persons life including their work, family, hobbies and interests. This enables staff to support people to settle into the home, by talking about and having knowledge of things which are indivudal to that person. One person we spoke with told us that they had chosen to move into residential care so that their was always someone their if they needed help, and so that they could feel safe. They told us that their daughter had visited before they moved in and that they were happy with their choice. Someone else told us that they had lived at Abbey House for sometime and that they were happy with their choice to move into residential care, and that they had made friends with other people living at the home. We looked at the records of four people living at Abbey House, and found that individuals had had their needs assessed by a Social Worker, before moving into the home, this enables the Registered Manager to look at the information provided and decide whether their needs can be met by the staff and facilities at the home. When someone moves into the home, their is a meeting after a month to review the care being provided and to find out whether everyone is happy with the care and support provided and can be confident that a persons needs are being met. A further review takes place after six months from then on an annual review is carried out. The four records that we looked us told us that the needs of people were being met by the staff at the home, and that individuals along with their relatives had expressed satisfaction with the care provided. We spoke with two visitors who were visiting relatives, they confirmed that the care their relative receives is regularly reviewed, and that the meeting includes them, their relative and others involved in the persons care along with the Social Worker, this ensures that the care provided is regularly reviewed to ensure that individual needs are being met. Care Homes for Older People Page 13 of 33 Care Homes for Older People Page 14 of 33 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 health and personal care that people receive is based on their individual needs, choices and expectations of care, and the principles of respect, dignity and privacy are put into practice. Evidence: We wanted to find out how the health and personal care needs of people living at the home were met. We spoke with people along with visiting relatives, and observed the care and support provided by staff, we also looked at the care plans and records of four people. When we asked people about the care they received they told us the most important thing is I feel safe and I know someone is always here if I need them, the staff are lovely and are very kind, and they always bring me a cup of tea in bed. Someone else said its lovely here and I am well looked after and I dont want for anything. We sent surveys to people who live at the home and their relatives and asked them Care Homes for Older People Page 15 of 33 Evidence: about the care they receive and whether they have access to health care, everyone expressed satisfaction saying that their needs were met and that they had good access to health care services and records we looked at confirmed this. Care plans we looked at contain good information about the care and support individuals require and the role of staff in providing the support. The information contained within care plans with regards to the care and support people with dementia receive could be expanded upon, to include information about how staff are to support people in orientating themselves along with information on how to manage difficult situations by the use of distraction techniques when someone becomes anxious. We found that the care plans we looked at were regularly updated and had been signed by the person themselves or their relative. Care plans include information about a persons life before moving into the home and we sat with people and talked with them about their care plan, they confirmed that the information recorded was accurate and was carried out by staff at the home. We observed staff throughout the day using the information detailed within care plans to provide the support people need, which included helping people move around the home which in some instances required specialist equipment. We also saw staff speaking with people about whats important to them such as family, this confirmed staff read and follow care plans and use the information about a persons lifestyle to reassure them and talk with them. Staff we spoke with had a good understanding of the needs of people living at Abbey House and knew about their family and work life, staff were polite and courteous and encouraged people to make decisions throughout the day. Records we looked at showed us that people living at the home have access to a range of health care professionals, and that additional areas of care are assessed to ensure that people receive the care and support they need. We also noted that people are supported to attend hospital appointments. We looked at the medication and medication records of the peoples whose records we had viewed, and found them to be in good order. We also looked a the medication and medication records of two people who were prescribed a Controlled Drug which were in good order. Records we viewed showed us that staff responsible for the administration of medication have been trained. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities are available for people to engage in activities, but these are not far ranging and are dependent upon the availability of staff to provide them, and the ability of people to participate. Abbey House provides a wholesome and varied diet. Evidence: We wanted to find out about how people spend their day, and how the staff working at the home support people to make decisions and stay in contact with relatives and friends, we did this by observing people throughout the day, talking with people living at the home and by looking at the care plans and records of four people. Abbey House has a relaxed atmosphere, with people getting up and spending time where they choose too, for some this meant staying in their bedroom, whilst a majority sat in one of the five communal areas in the home. We sat with one person when we first arrived at the home, they told us that they like to get up early and have a cup of tea before coming to the dining room for breakfast. They told us that they go out occasionally but are content to stay in the home as they struggle to walk any great distance, they went onto tell us that they continue to enjoy knitting. We spoke with someone else and their relative and they told us that they would like to go out more Care Homes for Older People Page 17 of 33 Evidence: often, the relative felt that the opportunities for people to go out were insufficient, a second relative we spoke with expressed the same view point, and felt their relative would like to go out most days, even if this was a walk around the local area. We sent surveys to people who live at the home, and they indicated that they take part in the activities provided by Abbey House. At the previous inspection of Abbey House in July 2007, we recommended that the hours of the Activity Organiser were increased to enable people living at the home to have an increased opportunity in accessing recreational and leisure events. We found by visiting the home that Abbey House no longer employs an Activity Organiser and the responsibility for providing activities is the responsibility of a member of care staff who is allocated this task on designated days of the week. Monday afternoons a board game or craft session is held and on a Friday afternoon bingo is played. On a Wednesday morning a group of people visit the local Allotment Society to take part in its coffee morning. The notice board detailed outings organised for the Summer, which included trips to Woodlands Garden Centre, a meal out at Waterside Inn at Mountsorrel and a barge trip in Mountsorrel, the Registered Manger told us that small groups of people go on outings supported by staff on accessible transport. Information provided by the Registered Manager in the self assessment tool which we received prior to our visit detailed that a Church Service/Communion is held in the home on a monthly basis and that a dog and its owner visit the home as part of a recognised scheme which provides an opportunity for people to have contact with an animal. We noted that Abbey House has a budgerigar which is in the lounge of the first floor. We observed on our visit that people in the main sat in one of the communal rooms, all but one having a television which was turned on, some people were taking an interest in the television programme, whilst others showed no interest at all. We noted some people received visitors, and staff spoke with people living at the home for brief periods of time, this meant that in many instances people are sitting with nothing of interest around them. Care plans need to be further developed to reflect the individual hobbies and interests of people, which are put into practice as people living at the home should not be restricted to group activities, which many of the people at the home cannot participate in due to their health care needs. At the weekends care staff are responsible for additional ancilliary duties which inlude the laundry and the making of beds, which restricts the time they have to spend in speaking with people living at the home, their are no planned activities at weekends. Care Homes for Older People Page 18 of 33 Evidence: Abbey House provides a visitors room, which relatives and those living at the home can use to meet if they do not wish to remain in the communal areas or in the persons bedroom. Abbey House encourages visitors, and there are no restrictions as to the time or frequency of visits. When we arrived at Abbey House in the morning we found some people were eating their breakfast in the dining room, they told us that they usually had cereals and toast. At lunchtime we went to speak with some of the people whose records we had looked at, they told us that they like the meals at the home, and they preferred plain English diet. They told us their was always a choice available. Surveys we sent to people living at the home expressed satisfaction with the meals provided. Care Homes for Older People Page 19 of 33 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. Individuals living at Abbey House are able to express their concerns and are cared for by staff trained in safe guarding adult processes. Evidence: We wanted to find out how the staff of Abbey House promote the safety and welfare of people who use the service, written information supplied by the Registered Manager before our visit told us about the policies and procedures which advise people on how to complain. The information provided also told us that the home has not received any complaints in the last twelve months, and we have not received any complaints or concerns about Abbey House. We looked at the training records of staff who were keyworker to the people whose records we had viewed and found that they had received training on how to safeguard adults from abuse, this training includes information as to the role staff have and their responsibilities in reporting any concerns they have about the welfare of people living at the home. The information provided prior to our site visit advised that all staff have received training in this area. Surveys which we received from staff told us that they know what action to take if someone wishes to complain. We sent surveys to people living at the home these told us that should they feel unhappy they would speak with a relative or member of staff, but a majority of Care Homes for Older People Page 20 of 33 Evidence: surveys indicated that they were not aware of the homes complaints procedure we gathered the same information by speaking with people living at the home. We noted that people living at the home attend meetings, and the minutes of meeting held the previous year recorded that the right to complain was discussed, given that people are moving into the home on a continuous basis, this is something which should be discussed at all meetings, with people being given a copy of the complaints procedure. Care Homes for Older People Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Abbey House provides a comfortable and homely environment which is well maintained the decor of the home does not consider or support the welfare of people with specific needs. Evidence: We walked around Abbey House, all communal areas of the home were decorated to a reasonable standard, we noted that communal areas had patterned carpets and wallpaper which does not support the well-being of people who have Dementia, we also noted that some areas of paint work were damaged, and wall paper was torn in places. Abbey House would benefit from having communal areas decorated with consideration to how patterns and colours are used which will help and support people with Dementia in orientating themselves within the home whilst promoting their independence and wellbeing. Abbey House employs a domestic staff team who work seven days a week to keep the home clean and tidy, on the day of our visit the home had a relaxed atmosphere and was in good order. Abbey House has a car park to the front of the home, with level access entrance. The front door is secure preventing people entering or leaving the home without ringing Care Homes for Older People Page 22 of 33 Evidence: the bell or using the keypad code system. The entrance foyer is large and includes a seating area with a television. Their are a further three lounges on the ground floor, two of which have a television. In addition the dining room has a visitors room, which people can use if they prefer some where private to talk. The dining room is located on the ground floor. The first floor has a lounge, and we noted that this lounge has a resident Budgerigar. Bedrooms and bathing/shower facilities and toilets are located on the ground and first floor, with bathing and shower facilities adapted for people with mobility difficulties. There are no en-suite facilities available. One person we spoke with said they had recently moved into one of the larger rooms and they were enjoying the additional space. Relatives we spoke with said the home is always fresh and clean, which was confirmed by surveys we received from people living at Abbey House. Abbey House has a garden to the side of the home, the access to this is via the dining room, their is a ramp which enables people with mobility difficulties to access the garden. The garden has mature plants and shrubs and a lawn area along with seating and tables. The garden at the time of our visit needed some maintenance as the home is currently without a handyperson whose role includes maintenance of the garden. We did note however that individuals living at the home prefer to sit on the benches at the front of the home by the entrance, they told us this was because they could see people arriving and leaving. Care Homes for Older People Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ability of people to live a lifestyle of their choosing is restricted by the number of people working at the home. People are cared and supported by staff who are recruited following a robust process and receive training relevant to their role and responsibilities. Evidence: We spoke with staff who work at the home and sent them surveys and asked them for their views as to whether staffing numbers are sufficient to meet the individual needs of people living at Abbey House, responses indicated that staff are confident that they can meet the needs of people. We spoke with the Registered Manager who said that staffing levels had not been reviewed for sometime, and stated that staffing levels were not always sufficient to meet needs. The Registered Manager told us that when they produce the rota they ensure their are five care staff on duty in the morning, but on a day to day basis given staff sickness and annual leave, their are usually four staff working in the morning. Our observations were that a majority of people living at the home choose to sit in the communal areas, which meant staff could easily observe and ensure people were well. Staff regularly were seen in the communal areas, including when drinks were served. However no activities took place and people living at the home were reliant on Care Homes for Older People Page 24 of 33 Evidence: occupying themselves, which included for some watching television, knitting or reading, a majority of people however sat in an armchair and appeared to not interact with their environment or anyone around them, unless staff approached and spoke with them. Staff were busy throughout the our site visit, and whilst staff did interact with people, the time available to them was limited. The Registered Manager told us that Abbey House has recently started to provide respite care, which will have an impact on both senior and care staff, with increased management and day to day care needs to meet. We were also told that at the weekends care staff have the additional responsibility of making beds and undertaking the laundry. It is necessary for all staffing levels to be reviewed with regards to delivery of care and support, provision of activities and day to day duties such as laundry, to ensure that the day to day lives of people receiving care is not affected, and that they are supported to live a lifestyle of their choosing. We spoke with visitors on the day of our site visit, and all indicated that their relatives would like to go out more, and comments within surveys support this. Information we received from the Registered Manager prior to our visit told us that 92 of staff have attained a National Vocational Qualification in Care. We looked at the training records of some staff working at the home and found that staff received training in topics which support and maintain the health, safety and welfare of people living at the home, which include training on moving and handling, infection control, basic food hygiene and safeguarding adults from abuse. Staff also receive training in areas which enable them to have a greater understanding of the needs of people which includes dementia awareness. Discussion with the Registered Manager evidenced that the quality assurance system in place does not review the effectiveness and impact training staff receive has on people living at the home and whether it improves the quality of their lives, this is an area for improvement to ensure that training is effective as well as enabling the Registered Manager to identify additional training required. We wanted to find out how staff were recruited and whether the recruitment of staff promotes the health and well being of people who use the service. The recruitment of staff at Abbey House is managed by the Human Resources Department of Leicester City Council, where records are kept, we therefore could not view these. Information supplied by the Registered Manager within the self assessment tool stated that staff are recruited following a robust procedure, which includes seeking two written references and the obtaining of a Criminal Record Bureau (CRB) disclosure, which Care Homes for Older People Page 25 of 33 Evidence: ensures that people who they employ to work with vulnerable adults are checked as to their suitability. Surveys we received from staff told us that when they were employed their recruitment and induction process was robust. Care Homes for Older People Page 26 of 33 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 management of Abbey House encourages and includes people who live at the home and its staff to share their views to ensure that the home is run and managed well. Evidence: The Registered Manager of Abbey House Mrs Jennifer Glover has worked at the home for many years, and has gained a National Vocational Qualification (NVQ) in Care at level 4 and the Registered Managers Award, this along with regular training that she accesses on an ongoing basis, enables her to manage the home well. Training recently attended included training on the Mental Capacity Act which includes Deprivation of Liberty Safeguards, the purpose of this legislation is to ensure that people are enabled to make decisions for themselves. whose purpose is to ensure that the rights of people are promoted. The Registered and Assistant Manager along with care staff were able to respond to Care Homes for Older People Page 27 of 33 Evidence: our questions, and had a good understanding of the day to day running of the home and the needs of people living in the home. We observed good team working which ensures people living at the home are cared for and have their health and personal care needs met. The Registered Manager has sent out surveys to people who live at the home and health care professionals who provide additional care and support, this has been done to ascertain the views of others with regards to the service that Abbey House provides. A number of these have been returned which we viewed, comments and answers to questions had positive responses which praised the service. We asked the Registered Manager what she would do with the information when surveys had been returned, they advised us that any issues identified within surveys would be addressed. We suggested to the Registered Manager that a report be produced with the findings and outcome of the surveys which included any action or plans the home will undertake to address any issues identified to improve the care and support people receive, and would be circulated to all relevant parties. Meetings are held for people who live at the home, and we read the minutes of these, we saw no evidence that the minutes of meetings are circualted to people living at the home. We saw some evidence of the views gathered from these meetings were discussed at staff meetings, this needs to take place routinely to ensure that all information is shared between people who live and work at the home to promote good care practices and ensure that everyone is consulted and are confident that their views are acted upon and considered. Information provided by the Registered Manager prior to our visit was factual, but did include information as to how the day to day running of the home impacts on people living at the home. The quality assurance system needs to be further developed so that the impact of actions taken by the home can be measured to ensure that people living at the home receive positive outcomes that support ongoing improvements to their daily lives and the service they receive. Records which we requested were readily accessible and were in good order, this shows that the home has good systems for recording information. We discussed with the Registered Manager that the information recorded about peoples day to day lives was limited in content, and could include further information about how people spend their day and any views they have made. We spoke with staff and looked at the information staff had recorded within the surveys we sent them, we found out that staff are supervised by the Management Team, and attend regular meetings and that staff feel supported. Care Homes for Older People Page 28 of 33 Evidence: Information the Registered Manager supplied prior to the site visit details the regular maintenance of equipment and systems in the home, including heating and electrical systems along with fire fighting equipment and systems. Care Homes for Older People Page 29 of 33 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 30 of 33 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 1 26 18 The Registered Person to review staffing levels with consideration to care and laundry staff. To ensure that the needs and welfare of people are met, reflective of person centred care, individual choices and preferences. 07/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Information in the form of the Service User Guide to be designed in a format which is reflective of the needs of people who use the service and enables people to make an informed choice, with consideration to the size and type of font used, and the inclusion of photographs. Social Workers provide prospective service users with information about the home, including the homes Statement of Purpose and Service User Guide as part of the assessment process. The care plans for people with dementia are further developed to include guidance for staff on managing Page 31 of 33 2 1 3 7 Care Homes for Older People behaviour including distraction techniques and other information relevant to supporting and enabling the person with their orientation including assistive technology. 4 5 12 12 Care plans should be developed to include the hobbies and interests of people living at the home. Abbey House to employ an Activity Organiser to organise and facilitate individual and group activities and recreational events. People living at the home are provided with a copy of the Complaints Procedure, and their right to complain is regulalry promoted within the home. Abbey House to review the standard of decor with reference to how colours and patterns influence the wellbeing of people with Dementia, and make the necessary changes. A system is developed which measures the effectiveness and impact staff training has on the care and support people living at the home receive to ensure positive outcomes for people. A report is produced which provides information gathered from the quality assurance process, and includes actions and plans the home intends to make to improve the care and service provided. The report is discussed at meetings and a copy given to people who live at the home, their relatives and others who provide additional care and support. 6 16 7 19 8 20 9 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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