Care Home: Abbeydale Residential Care Home

What the care home does well Abbeydale residential home has a warm, friendly and comfortable atmosphere. All the residents we spoke with told us they were happy at the home and were positive about the staff team. One resident told us, "Its quite nice here, I`m enjoying it. Its clean too". Residents are treated with respect and their privacy is maintained. People who use the service said they were satisfied with the food provided and that they were always offered a choice. The home is clean, well maintained and decorated to a good standard. All residents have care plans, detailing their care needs and these needs are reviewed on a regular basis. People are able to have a say in how the home is run and visitors to the home are encouraged and made welcome by staff. What has improved since the last inspection? One requirement was made at the last inspection. This related to obtaining satisfactory criminal records checks for staff employed at the home. This requirement has now been complied with and recruitment checks are now more robust. We also made a good practice recommendation that all staff at the home undertake more in-depth dementia training. The manager told us he was looking into this and we have restated the recommendation in this report. What the care home could do better: As a result of this inspection one new requirement and one new good practice recommendation have been issued. To ensure that there is a more varied diet at the home, the menus must be reviewed with residents. The registered manager should look at alternative floor coverings for rooms where odour is a problem. Key inspection report Care homes for older people Name: Address: Abbeydale Residential Care Home 51-53 Fox Lane London London N13 4AJ     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: David Hastings     Date: 0 1 1 2 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: Abbeydale Residential Care Home 51-53 Fox Lane London London N13 4AJ 02088825311 02088826511 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brownlow Properties Limited Name of registered manager (if applicable) Liam James Heneghan Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 1. The registered provider may provide the following category of service only: Care Home only - Code 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 caategory - Code OP Dementia - Code DE 2. The maximum number of service users who can be accommodated is: 21 Date of last inspection Brief description of the care home Abbeydale Residential Home is privately owned by Brownlow Properties Ltd, which has a number of other care homes in London. The home is registered to provide personal care for twenty-one older people who may also suffer from dementia. The premises consists of two adjoining three storey houses that have been significantly renovated and improved by the current registered providers. There are four single Care Homes for Older People Page 4 of 25 Over 65 21 21 Brief description of the care home bedrooms on the second floor; seven single and two double bedrooms on the first floor and two single and two double bedrooms on the ground floor, all bedrooms have ensuite facilities. There are additional toilets and bathrooms throughout the building. A passenger lift and stairs connect the three floors. The homes main communal area is situated on the ground floor and consists of a large day room divided into a lounge and dining area. The homes kitchen, laundry, offices and staff facilities are also situated on the ground floor. The home also has a landscaped rear garden that is accessible and very attractive and contains a small conservatory that is now the homes designated smoking area. The front garden is paved and provides off street parking for the home. The home is situated in a residential area of the London Borough of Enfield and is situated close to the shops, amenities and public transport links in Palmers Green. The stated aim of the home is to provide a safe and homely environment where the unique needs of each individual are recognised and skilled staff are available to provide care and support in a way that encourages self-determination and enables each person to achieve their best possible quality of life. The fees for the home are between four hundred and seventy five pounds and five hundred pounds per week. The provider organisation must make information about the service, including CQC inspection reports, available to people considering a place at 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: We carried out this unannounced key inspection of Abbeydale on Tuesday 1st December 2009. The name of the company has recently changed and as such this is seen as a new service and requires a new key inspection by the Commission. A key unannounced inspection took place in April 2009. We were assisted by the registered manager and deputy manager who were open and helpful throughout the inspection. We spoke with 10 people who use the service and five staff members. We looked around the home and examined various care records, staff files and health and safety documentation. Care Homes for Older People Page 6 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 7 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 8 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. 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. Evidence: We examined two assessments of people who have recently moved into the home. The manager told us that he would always visit a prospective resident and carry out an assessment of their needs before they moved in on a trial basis. These assessments were detailed and covered all the elements required by this standard including the assessment of physical, social and cultural needs. We also found that the information from these assessments was being recorded on peoples care plans as well. There was evidence on files that people had a review of the placement after four to six Care Homes for Older People Page 9 of 25 Evidence: weeks so they could decide if the home was right for them. Care Homes for Older People Page 10 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. Care plans clearly set out residents health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. Evidence: We examined the plan of care for six people who use the service. Plans were clear and easy to follow, and subject to regular review. Care plans covered needs around personal care, communication and mobility. The service is in the process of updating all peoples care plans to a new format that is more detailed and easier to follow. Each persons plan of care included an assessment of the risk of falling and how staff are to reduce this risk, for example, having two staff to help with personal care tasks or by supervising the resident when they walk around the home. Care Homes for Older People Page 11 of 25 Evidence: The service has also carried out assessments for other risks associated with individual people residing at the home. For example, risk assessments were seen in relation to nutrition, moving and handling and pressure care. On the day of the inspection people using the service looked well cared for, their clothes were clean and they were appropriately dressed. Visits by health care professionals such as doctors, district nurses, chiropodists, dentists and opticians were being recorded on plans we examined. These showed that people had good access to these professionals. The manager told us that residents see health care professionals in their own rooms to ensure privacy. Satisfactory records were examined in relation to the receipt, storage, administration and disposal of medication. Records indicated that staff have undertaken medication training and only qualified staff administer medication at the home. Medication was being stored securely and being administered and recorded accurately. Each persons medication chart has a picture of them attached to it so that staff can double check who is receiving the right medication. Where medicines have been prescribed on an as required basis there was clear instructions on peoples care plans to let staff know when this medication should be given. We saw a number of examples of supportive staff interactions with people and staff were able to describe to us how they ensure the privacy of people they support. We saw staff knocking on residents bedroom doors before entering. People we spoke with told us that the staff were respectful and kind towards them. One resident told us, The staff are very kind. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides varied activities for people who use the service in order to keep them suitably occupied and engaged. Visitors to the home are encouraged and welcomed. Residents are able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet. The menu needs to be reviewed so that residents can enjoy a more varied diet. Evidence: There appeared to be enough staff on duty to make sure that residents were suitably engaged and occupied. Staff were observed sitting and chatting with residents and a number of activities were taking place. Residents were clearly benefiting from the staff contact and residents appeared happy and relaxed. People told us they enjoyed the activities at the home. One resident commented, I go out for a walk with my friend every day if the weather is nice. Although we did not see any visitors during the inspection, residents told us that visitors were made welcome and could visit at any reasonable time. Care Homes for Older People Page 13 of 25 Evidence: The home has regular residents meetings so that residents can have a say in how the home is run. Staff we interviewed were able to give us practical examples of how they offer choice to people living at the home. This included times that residents wanted to get up in the morning and making sure that residents were able to choose the clothes they wanted to wear. One resident commented, They dont tell you what to do. On the day of the inspection the kitchen was clean and stocked with fresh fruit and vegetables. The cook was aware of any special diets that people needed and told us that there was always a choice of menu. Fridge and freezer temperatures were being recorded. Prior to this inspection the Commission received an anonymous complaint about the quality of the food at the home. People we spoke to told us they were satisfied with the food and confirmed that they were always given enough food throughout the day. One resident commented, The food is marvellous. Another resident told us the food was, Nicely prepared. Another resident commented, The foods not bad. We saw the record of meals prepared by the home for residents. There appeared to be a lack of variety of menu and meals were being repeated on a number of occasions. We noticed that beef burgers and mince meat were on the menu quite a lot. The deputy manager told us that the cook was trying new dishes and seeing how residents enjoyed these. This is a positive step towards providing more variety of meals at the home. A requirement has been issued that the menus are reviewed with residents so that more variety of meals are on offer at the home. Care Homes for Older People Page 14 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. Complaints are taken seriously and responded to in a professional manner. People at the home are protected from abuse by clear policies and procedures and by an appropriately trained staff team. Evidence: As mentioned previously, the Commission received an anonymous complaint about the quality of food provided at the home. The complaint also related to the qualifications of the cook and the quantity of food provided. We asked the registered manager to investigate these issues. Although the cook used to be a domestic at the home she has the relevant qualifications for the job including a current food hygiene certificate. Residents we spoke with told us they enjoyed the meals she prepared and that there was always enough to eat. We could find no evidence to support the complaint although we have made a requirement relating to the variety of meals available. The home has not received any other complaints since the last inspection. All the residents we spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. Staff were able to describe how vulnerable people could be at risk of abuse in a Care Homes for Older People Page 15 of 25 Evidence: residential care setting. All staff interviewed were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that we spoke to said they felt safe and well supported at the home. Records indicated that most staff have undertaken training in the protection of vulnerable people. Where new staff have not attended this training we saw that they had been booked to attend courses in the near future. The issue of vulnerability to abuse is identified in peoples care plans. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe, clean and maintained and decorated to a good standard. Evidence: We looked around the home and visited a number of residents rooms. The home was well maintained and decorated to a very good standard. Residents rooms were pleasant and individualised. We noticed that a few bedrooms had a strong odour. The deputy manager told us that a few residents have incontinence problems and that even though carpets are regularly cleaned some carpets still retain some odour. We discussed this issue with the registered manager and have made a good practice recommendation that other, safe floor coverings are considered for these particular rooms. The standard of cleanliness in all other areas of the home was excellent. There are four shared rooms at the home. Residents told us they were happy with their rooms. The home is on several floors and there is a lift to all floors. On the day of the inspection the home was clean and tidy. The home employs domestic workers and the residents we spoke with confirmed that the home was always clean. Care Homes for Older People Page 17 of 25 Evidence: The laundry area was clean and all toilets and bathrooms had paper towels and antibacterial soap. Staff have undertaken infection control training and one member of staff has been nominated as the infection control team leader. 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 who use the service are supported by a friendly and caring team of staff. These staff would benefit from further training in dementia care so they are aware of the issues faced by residents who have dementia. Recruitment practices are robust enough to protect residents at the home. Evidence: One the day of the inspection there were three care staff on duty in the morning and two staff on duty during the evening. There are two waking night staff on duty throughout the night. The deputy manager works both morning and evening shifts. People who use the service told us they were happy with the staff at the home and we saw good interactions between staff and residents. On the day of the inspection there appeared to be enough staff to meet the needs of the residents. Staffing rotas seen matched the names of the staff on duty that day. The home has employed staff from cultures and backgrounds that match the cultural needs of residents they support. One resident told us that the staff are, Excellent. Another person we spoke with told us, They have so much patience. The deputy manager told us that seven of the thirteen care staff have completed their NVQ qualification. A number of staff are qualified nurses in their own country. Care Homes for Older People Page 19 of 25 Evidence: Staff were positive about the training offered by the home and records and certificates seen indicated that most staff are attending the appropriate training they need to support people properly and safely. This training included medication, moving and handling, adult protection and first aid. Most staff have attended a short course in dementia care. This was only for half a day and it would be impossible to cover all the topics needed to support people with dementia at the home. This was discussed with the registered manager who agreed that further training in dementia care would be of benefit. We spoke with some staff who have found some issues around dementia care difficult to manage. A good practice recommendation has been issued that staff undertake further, more in-depth training in dementia care. This should provide staff with a fuller understanding about the issues facing people with dementia at the home. Two staff files were examined from staff recently employed by the home. We checked these files to see if the homes recruitment procedures were being followed so that residents are protected from unsuitable staff working at the home. Both staff files contained two written references, proof of identity and a satisfactory criminal records check. 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. The home is run by a competent and experienced manager. Residents have opportunities to have a say in how the home is run. Residents financial interests are being safeguarded. The health and safety of residents and staff are being promoted and protected. Evidence: The registered manager has a range of professional qualifications and experience that are detailed in the homes statement of purpose. This includes a number of years experience at a senior level in care provision. The registered manager has attained the care home registered manager award. There was also evidence that the manager continues to attend training courses in order to update his knowledge and skills. The registered manager told us that the deputy manager will be applying to the Commission to be the registered manager of the home. The home has a quality assurance policy in place. Surveys are given to residents and their relatives, to help gain their feedback on the level of care and support provided. Care Homes for Older People Page 21 of 25 Evidence: After collating the results of these surveys a report is published and made available to residents and their representatives. The last report was produced in January of this year and contained positive comments from residents and their families. The home does not hold any money on behalf of residents. The home has now started to invoice residents or their representatives for additional items or services purchased such as toiletries and hairdressing. The home has set up a small shop for residents so they can buy toiletries and other minor items. There is a price list of all items available from this shop. Two invoices for residents were checked and found to be accurate with clear audit trails. Fire extinguishers were situated around the home. Fire exits were clearly signed and free from obstruction. Fire alarms are tested weekly, and the home holds regular fire drills. The home had in date safety certificates for gas safety, PAT testing and electrical installation. Staff training records indicated that staff are undertaking the required health and safety training in order to protect both residents and staff. 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 1 15 16 The registered person must ensure that the menu is reviewed with residents. This should ensure that people who use the service are provided with a varied diet. 01/02/2010 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 2 26 30 The registered person should consider alternative safe floor coverings for the few rooms that have a strong odour. The registered person should ensure that all staff at the home undertake a more in-depth dementia training course so they have a better understanding of dementia care. 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. Re-publishing this information is in breach of the terms of use of that website. 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