Care Home: Abbeycrest Nursing Home

What the care home does well The home is clean, homely and welcoming. People`s comments about the home through our survey show that people are welcome, including `has a nice atmosphere` and `very pleasant and welcoming`. We saw that the healthcare needs of people living in the home are met. People say that the standard of care is good, and comments about the care at the home include: `no complaints`, `up until now everything fine` and `good, caring and helps everyone equally`. Comments about the care staff include: `staff very polite and helpful` `very accommodating`, `look after personal care with devotion and expertise`, `although the building appears tired, the warmth of the carers shines through`. What has improved since the last inspection? A new activities organiser has been recruited and is due to start work soon, so that the quality of daily life can improve for the people living there. There are no shared rooms now, and this has improved the level of privacy for individuals. The home has been implementing a new care plan format, so that all the needs of the people living there will be addressed. The way of managing the small sums of money kept for people living in the home has improved, so that they are more secure and accurate. The quality assurance system has improved, and now people using the service have regular opportunities to have their say about the quality of the home. An action plan is in use to itemise the tasks needing attention to improve the home. A residents` council has been formed, so that people living in the home will be able to give their views on issues such as staff recruitment. Staff training is now better organised, and staff are able to take some courses on the internet. The new home is nearing completion and plans are being developed for the smooth transition from the old home to the new. What the care home could do better: The manager is aware from the meetings with people living in the home that the numbers or allocation of staff numbers at key times of the day need to be improved. Key inspection report Care homes for older people Name: Address: Abbeycrest Nursing Home Essex Way Sonning Common Reading Berkshire RG4 9RG     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: Kate Harrison     Date: 1 7 0 6 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 25 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 25 Information about the care home Name of care home: Address: Abbeycrest Nursing Home Essex Way Sonning Common Reading Berkshire RG4 9RG 01189724414 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: abbeycrest@caringhomes.org Abbeycrest (Reading) Ltd care home 24 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 to be accommodated is 24 The registered person may provide the following category of service: Care home with Nursing (N) to servie users of the following gnder: Either whose primary care needs on admisison to the home are within the following category:Old age, not falling within any other category: (OP) Date of last inspection Brief description of the care home Abbeycrest is situated at the edge of Sonning Common village, near Reading. It can provide accommodation and care for 24 older people who require general nursing care. The building was originally a school and was converted for use as a residential care home in the 1980s. It is within reach of a local bus service, village shops, a library and the local surgery. Accommodation is provided in single rooms, equipped with a washbasin. None of the rooms has a en-suite lavatory. There are 3 bathrooms - one on the ground floor and 2 on the first floor - and 3 separate lavatories. Not all the bathrooms are in use. A small Care Homes for Older People Page 4 of 25 Over 65 24 0 Brief description of the care home passenger lift and stairs serve the first floor. There is a dining room and sitting room on the ground floor and a sitting room on the first floor is also used for staff training. There is a very small room used as a laundry on the first floor and a kitchen on the ground floor. A new building is nearing completion within the grounds, and the home will close when all the people living in the home are transferred there around the end of 2009. The home overlooks a stretch of common land and public right of way across the fields at the rear. A paved patio area with garden seating is accessed from a fire exit door. There is a gravelled parking area for cars at the front of the home. Care Homes for Older People Page 5 of 25 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: This inspection of the home was an unannounced Key Inspection, and was carried out by one inspector between 10.15 and 16.00 during the day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home through the homes self assessment document, the Annual Quality Assurance Assessment (the AQAA) and any other information we received about the home since the last inspection. The AQAA was completed before the present manager was in post, and did not contain all the information we needed. We saw the communal areas of the home and some private rooms used by people living there. We looked at records and documents relating to the care of the people living there. We saw recruitment and staff training information and looked at how peoples medication was managed. We asked the views of the people who live in the home, through questionnaires we had sent out. We spoke to some individuals about their lives in the home during our visit, and we spoke to one healthcare professional about their view of the service provided Care Homes for Older People Page 6 of 25 by the home. Altogether we received 11 completed surveys from relatives, staff, a healthcare professional and from people living in the home, and their views are reflected in this report. We spoke to the manager, some staff members, and a senior manager from the company, and discussed the running of the home with them. This inspection was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgements about the outcomes for the people living in the home. The date of our last key inspection was 28th June 2007. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 8 of 25 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 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of individuals are assessed before they move into the home, so that people can be confident that their needs will be met. Evidence: We saw the pre-admission assessments of three individuals to check how the home carries these out. The home uses the companys 10 page document, gathering information about all the individuals needs. The manager or another registered nurse visits the individual to discuss their needs, and a decision is made and recorded about the homes ability to meet their needs. We saw that information from healthcare professionals was also available, to make sure that the home had the information necessary to look after the individuals. We spoke to one individual who told us that there was enough information available before moving into the home, from visits before admission and from the information provided by the home. All the people who responded to our survey question about information said that they received enough before they made the decision to move into the home. Care Homes for Older People Page 10 of 25 Evidence: The home does not provide intermediate care. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their personal and healthcare needs met, in a caring, respectful way. Evidence: The home is introducing new documentation, and all the individual care files do not yet contain the new documentation. The new documentation includes care plans for meeting the social and emotional needs of people, and work continues to complete the introduction of these care plans to all the files. We looked at the care files for three individuals and saw that risk assessments were carried out for care topics, such as falling, keeping the environment safe, pressure damage to skin and nutrition, and that care plans were completed to meet the physical needs of the individuals. We saw that the home keeps records to show when healthcare professionals visit individuals, and people living in the home told us that they usually or always receive the care and support they need. One individual said that the staff team has to work hard to meet the needs of all the people, particularly in the morning and after 6.30pm. We spoke to a healthcare professional who told us that the home was improving in the way it supported the nursing staff to gain the skills necessary to manage tasks in the home, Care Homes for Older People Page 12 of 25 Evidence: so that the need for input from the community nursing staff was reduced. We noted that care plans are reviewed regularly, and that changes to care are documented. We looked at how the home manages medication. No one at the home manages their own medication, and nurses at the home are responsible for managing it for them. The home is considering how best to document the fact that people prefer the home to manage their medication. There is a system in place for recording the reception, administration and disposal of medication, and regular audits are now carried out to identify any improvements necessary to the system. We discussed the way the home records the administration of creams that are not seen as the responsibility of the nurses, and the home has changed procedure to make sure that the person who administers the cream will in future sign the record. We noted that the home records the individual preferences of individuals, regarding privacy and dignity, such as staff knowing the individuals preferred name and their preference about how to spend their time. We saw that people were dressed well and looked well groomed, and heard staff members respectfully talking to individuals. The majority of individuals living in the home who responded to our survey said that staff usually listen and act on what they say, and two individuals said that staff always do. One individual said that the care in the home is of a good standard. Care Homes for Older People Page 13 of 25 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. Daily life can be monotonous for people living in the home, due to the lack of a regular activities routine, though this may improve once the activity organiser starts work. Evidence: The homes information document Service User Guide February 09 states that activities scheduled as per the wishes of service users. At our inspection in June 07, outcomes were poor in this area, due to the lack of activities provided. Since then the home has made efforts to improve daily life for people, by using the services of the activities organiser from a nearby home for a period of time. The home has been without an organiser for some months, but recently has recruited a person to be responsible for the provision of activities, working on a part time basis, to start work in the near future. We noted that care plans were not always created to make sure that the preferences of individuals about activities were carried out, and the manager explained that the home was implementing new documentation about care planning, to include a social care plan. At present there are visits from entertainers, seasonal entertainments and celebrations. The staff team provide some individual activity, such as walking around the garden and hand massage, but our survey results show that the majority of people living in the home say activities are only sometimes arranged that they can take part in. One person said used to, and one individual said that Care Homes for Older People Page 14 of 25 Evidence: previous activity organiser did a good job. One relative said in our survey that could have more one to one engagement, and records show that the lack of activities was discussed at the Residents Meeting in May 09 and the Relatives Meeting in April 09. The manager is aware of the need to provide more activity, including outdoor activity, so that the home meets its statement in the Service User Guide, and is working towards improving the provision when the new activities organiser starts work. One person who responded to our survey said that there were problems with television reception in some rooms, and this has now been addressed. Improvements have been made to the garden area, so that individuals can safely use the area, and one individual said how she/he enjoyed the new flower tubs. Visitors are welcome to the home, and relatives meetings are held regularly to discuss any issues arising with the homes manager. People are supported to keep in touch with their religious practices, through visits from ministers of religion to the home on a regular basis. People told us through our survey that the home provides food that they usually like, and one individual told us that there was good choice of main meal, a good choice of fruit daily, and that the kitchen staff looked after them well. We talked to people in the dining room after lunch, and people told us that they had enjoyed their lunch, and one person told us that the kitchen staff are marvellous. Care Homes for Older People Page 15 of 25 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 living in the home and their relatives are confident that any complaint will be investigated and that they will be safe from harm, because of the homes procedures. Evidence: We saw the complaints procedure displayed in the entrance hall, and it showed how to make complaints and concerns known to the home. It contained information about whom to make the informal and formal complaints to, and showed the timescales so that people understood that their complaints would be quickly addressed. The complaints procedure was recently revised to make it simpler to complain, and all the people who responded to our survey said that they knew how to make a complaint. One individual told us on the day of our visit that the manager was easy to approach with concerns, that she was dependable, and that concerns were quickly addressed. All the staff team receive training about how to safeguard vulnerable people, and we saw that safeguarding training starts at induction and is continued on a rolling basis. The manager and staff team are aware of the local safeguarding procedures and the manager makes any referral necessary. She makes sure that we are aware of any referrals, and we received information about one recent referral to the safeguarding team. Care Homes for Older People Page 16 of 25 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. The home is clean and regularly maintained, but people living in the home are not able to shower or bath when they want to, due to the poor facilities available, and are looking forward to the new facilities in the new home. Evidence: At our inspection of June 2007 the outcomes for this area was Poor, due to the lack of bathing facilities and inadequate refurbishment. One bathroom is used as a storeroom, while another has limited use due to the lack of space. The owners of the home decided to build a new home instead of making more adaptations, and work on the new building is currently nearing completion. One individual spoke to us about the facilities, saying that she/he uses a bowl of water to wash when the bathroom is unavailable, and that she/he is looking forward to moving to the new home as then she/he will be able to shower or bath when they want. The home has no sluicing facilities, and has taken advice about the safe way to clean commodes and urinals. A sluicing facility is planned for the new building. We discussed the recommendation made at our last inspection, about continuing to carry out checks to make sure that the environment did not further deteriorate while awaiting the move to the new home. The manager said that a new person with responsibility for maintenance has started work, and general maintenance continues on a day to day basis. Rooms are refurbished before a new person arrives, and the dining room has been improved. Care Homes for Older People Page 17 of 25 Evidence: People told us through our survey that the home is usually fresh and clean, and we noted on the AQAA that regular quality audits are carried out regarding cleanliness. The home has an infection control policy, and most of the staff members have received infection control training. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are looked after by safe well-trained staff members, usually in enough numbers. Evidence: We saw from three staff recruitment files that the home carries out checks on prospective employees to make sure that they are safe people to employ, and that all the information about them is available before allowing a person to start work in the home. We discussed induction training with the manager and with one recently recruited person, and we noted that the induction training is to the necessary standard. The home has support from the companys regional trainer to make sure that staff members attend all key training, and we saw the training records for the staff members in the home showing what training they attended and what training was outstanding. Training is a mix of internet based learning and group led courses. There is a training programme for registered nurses and one nurse told us about the training she received about medication. The home encourages staff to take the National Vocational Qualification Level 2 in Care, most of the staff members hold the qualification, and several have completed the NVQ Level 3. The staff rota shows the mix of nurses and care staff on duty on a daily basis. We asked in our survey if the staff members were available when people living in the home needed them, and the majority replied always or usually. One person told us that sometimes there were not enough staff around in the morning and in the Care Homes for Older People Page 19 of 25 Evidence: evening. We noted that this issue was discussed at the last Residents Meeting, and the manager is aware of the need to improve staff numbers at these times. People said about the staff team: well looked after by staff who care, very helpful, staff very polite and helpful, Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their views heard and can depend on the home to act in their best interests. Evidence: The homes AQAA was completed by an acting manager before the current manager took up her post, and we discussed how the AQAA could be improved with the manager, as not all the necessary information was included in the current document. The manager took up her post in April and is going through our registration process, to become the registered manager for the service. She attends Residents and Relatives meetings and took action about the lack of activities provided by recruiting an activities organiser, who will start work soon. We discussed individual issues arising from our survey, and the manager took action to address these issues quickly. The home has developed its quality assurance programme since our last inspection visit. A senior manager from the company was in the home during our inspection visit, to support the manager to improve the care and record keeping, by carrying out a monthly home audit. Surveys are sent to relatives, healthcare professionals and Care Homes for Older People Page 21 of 25 Evidence: people living in the home to check the quality of the service, and the home is planning to share the results of the May 09 survey when these are collated. The home manages small amounts of personal monies for some people living in the home, and keeps these securely with records of transactions. The company has a Facilities Management Department responsible for the safe operation of the homes services, and the AQAA shows that the maintenance of equipment such as hoists and the passenger lift is in place and is up to date. The home has a Health and Safety policy statement and provides training for staff in safety procedures, such as moving and handling people. There is an identified person responsible for Health and Safety, and a Health and Safety committee meets regularly in the home to make sure that procedures are in place to protect staff and people living in the home. A fire risk assessment is in place, and staff receive training about fire safety regularly, including key information on the first day working at the home. The new home is taking shape and the company is planning the move to minimise disruption to the people living in the home, by sharing information and discussing the move regularly. Comments from our survey about the home from relatives and people living in the home include: like being home from home, the whole atmosphere very pleasant and welcoming, 24 hour caring, the majority of staff caring and very pleasant. Comments about the manager included: since the new manager took over things have improved considerably, and she is dependable and approachable. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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