Care Home: Abbeyfield House

What the care home does well We think that Abbeyfield provides excellent outcomes for the people who live there. The ethos and approach of the home values people who have dementia and helps them to continue to lead fulfilling lives. The people who live there said `It`s very nice here`, `we get on well and that`s the main thing. Sometimes we want to do different things and it`s good that we can go all over` and `it`s very good here`. The majority of staff are person centred in their approach and relate to people very well. A full and varied programme of activities are on offer and these help people to be stimulated and occupied each day. The service helps individuals access and be part of the local community. The home environment allows people to move freely around the whole house and access the garden when they want to. What has improved since the last inspection? Due to a change in registration, this Abbeyfield home is now treated by CQC as a new service. However the service itself has not fundamentally changed and this report reflects that the home has continued to develop and improve. The manager and her staff have clearly worked hard to further develop the activities on offer, improve the environment and increase the skills of staff working there. What the care home could do better: There are still opportunities for the service to continue improving and establishing itself as a centre of excellence for dementia care. We have made a number of recommendations that signpost ways that the home could choose to do this. The organisation should seek to support the manager and her staff with training and resources. Some care staff still need to think about what being person centred really means and make sure that they are not task orientated. Observational tools could be used to continue to improve the quality of care provided at Abbeyfield. Key inspection report Care homes for older people Name: Address: Abbeyfield House California Road New Malden Surrey KT3 3RL     The quality rating for this care home is:   three star excellent 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: Jon Fry     Date: 0 1 1 0 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 26 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 26 Information about the care home Name of care home: Address: Abbeyfield House California Road New Malden Surrey KT3 3RL 02089490022 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): p.windmill@abbeyfield.com The Abbeyfield Society Name of registered manager (if applicable) Miss Paula Windmill Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following categories of service, Care Home only, Code PC, to service users of the following gender, either, whose primary needs on admission to the home are within the following categories, Dementia, Code DE Date of last inspection Brief description of the care home 36 Over 65 0 Care Homes for Older People Page 4 of 26 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: three star excellent 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: Two inspectors made an unannounced visit to Abbeyfield on the 29th September 2009. A further short announced visit was made by one inspector on the 1st October 2009 to look at records and documentation. We spoke with a number of people who live there and talked to staff members and the manager. One inspector used a methodology called the Short Observational Framework for Inspection (SOFI). This is a methodology we use to understand the quality of the experiences of people who use services who are sometimes unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. The home sent us their Annual Quality Assurance Assessment (AQAA) before we visited. This document was well completed and gave us good information about the Care Homes for Older People Page 5 of 26 service being provided. Care Homes for Older People Page 6 of 26 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 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A user friendly guide is available about the home. Individual needs are always assessed before admission and good information is captured to make sure that individual needs are met. Evidence: The AQAA from the home told us that the service user guide has recently been redesigned and is very picturesque with clear information specific to the home. These documents are available in various formats and are made available to all prospective residents/relatives. We were given a copy of this guide and saw that it has been made much more user friendly with photographs of key people and places. The home is currently updating its care plans and moving over to the Eden Alternative person centred planning format. The assessment forms used before admission have also been developed to capture better information for the persons care plan when they move in. We saw the assessments for two people and these were well completed. Care Homes for Older People Page 9 of 26 Evidence: Questions are now asked about what people have done in their past, important people and events in their lives and their preferred lifestyle now. We have recommended that the home keeps developing the assessment format. Ideas to consider could to ask what a good day looks like for the person, how do we know when they are happy and how to recognise if they are not. Care Homes for Older People Page 10 of 26 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 include good information about the person and are still being improved. Health needs are addressed and medication is managed well. Evidence: The homes AQAA told us that we are in the process of changing the format of all the care plans to a more person centred format. The original template which was being used by the local authority homes has been redesigned to suit our residents. The new care plan format captures some good individualised information about the person. The documents we looked at were a work in progress so it was difficult to fully assess the information being recorded. We have recommended that the home keeps supporting staff to record good quality individual information that is easy to access and use. There may be opportunities to change parts of the format to suit the home better and capture more about the individual. Other developments could include recording what works with the person and what doesnt, what a good day looks like and how to communicate effectively with the individual. Care Homes for Older People Page 11 of 26 Evidence: Abbeyfield develops a personal life story book for each person living there and these are used for reminiscence on a one to one basis and also as part of a group activity session. We saw one persons book that included lots of photographs of events and people important to them as well as a written life history. The home has a wishing tree where individual wishes are put and the home will then try to help the persons wish to come true. We saw that this is helping people have and achieve individual goals which is another important aspect of care planning within the service. Wishes that we saw include going to the seaside, taking a walk by the river, going to Hampton Court Palace and seeing a gorilla at London Zoo. Many wishes on the tree have turned gold to show that they have been achieved. We have recommended that the home looks at the respite care plans. Information for someone coming to stay there for a short period could be in a shorter format and then developed if the person returns for further stays. The respite care plan we saw was too general and did not offer specific guidance for staff about how best to support the person. Health needs are addressed well by the service. We saw good records are kept of appointments and individual assessments completed around moving and handling, nutrition and pressure area care. We looked at medication in one unit and saw that people are receiving their medication as prescribed with full records kept. Care Homes for Older People Page 12 of 26 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 service has a strong commitment to enable people to maintain their social, emotional, communication, and independent living skills. Mealtimes are generally a positive occasion but could be further improved for some people living there. Evidence: The AQAA told us that each resident is encouraged to take part in some form of activity within and outside of the home. We have a dedicated and experienced activities organiser to facilitate this. She has attended Eden training in Jan 09 and is part of a cluster group which is comprises of activity organisers from the Royal Borough of Kingston, private sector and Bupa. People told us that they had been to Worthing recently and some people from another home had also come along. We saw the activities organiser facilitating different activities on both days we visited and there are lots of photographs throughout the home showing different trips out and activities. Entertainers also visit the home regularly and people have the opportunity to take part in gardening and cooking. Key workers are given time with the person they support to go out into the community and an extra two hours each week has been allocated for them to do this. Care Homes for Older People Page 13 of 26 Evidence: We looked at the mealtime in two wings during our visit. The mealtime was facilitated in an unhurried manner but we saw that it was facilitated in a more pleasant and person centred on one wing. Staff on the other wing were too task orientated and focused mainly on ensuring that people were eating their meals. All the staff need to think about the importance of mealtimes as a social occasion and think about their practice when supporting people. The home should also extend its practice around staff eating meals with the people who live there and how everybody working at Abbeyfield could be involved with the occasion. The manager told us that work is continuing on the menus and picture menus are part of future planning. The boards on each unit can be difficult to read at a distance and a more visual display may help people know whats being served that day. There may also be opportunities for people to make more instant choices at the mealtime rather than choosing their meals the day before. The use of bibs at mealtimes should be also be further thought about. Care Homes for Older People Page 14 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns or complaints are taken seriously. Staff training helps to safeguard the people who live there. Evidence: The home told us in the AQAA that concerns and complaints are listened to and taken seriously and acted upon. We have a revised complaints procedure that is included in our Statement of Purpose and a laminated copy of the procedure in size A3 is clearly displayed in the care home. We saw that the guide about the service includes photographs of the manager and her line manager to help make sure that people know who to speak to if they are unhappy. A record of concerns or complaints is kept and this showed that any issues raised are looked into and responded to. Records showed that staff have training in Safeguarding Adults as part of their induction and this is refreshed regularly. A staff training day was seen to be scheduled for early October. Staff can access the Local Authority and organisational procedures when required. One Safeguarding issue had been looked into within the last year and we saw that this Care Homes for Older People Page 15 of 26 Evidence: had been handled appropriately by the service. Care Homes for Older People Page 16 of 26 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 provides people with a safe, comfortable and well maintained environment. Evidence: The home told us in the AQAA that we have decorated a downstairs unit and both the upstairs units to provide more contrasting colours to assist residents with orientation and navigation. We have also placed a variety of framed paintings and artificial/ real flowers. These changes involved the residents living on those units. We have items placed around the home for reminiscence, some if these items are a spinning wheel, old phones, sowing machines, bed pan, two rummage boxes, pictures and two hat stands full of hats,bags and scarves. Care is provided in four wings and each one is named after a colour. People living there are able to move around the home freely and this includes the garden and patio areas. This is a strength of the home where individuals are not restricted by keypads and door locks. We saw that the environment is clean, comfortable and homely. Each person has their own room with en-suite facilities. These are personalised to the individual and each room is identified by pictures or a memory box. Some good work has been done to make the environment more stimulating and Care Homes for Older People Page 17 of 26 Evidence: interactive. We had a positive discussion with the manager about how this could be developed further by bring in more items for people to use and engage with. These items do not have to be associated with reminiscence and need to be made available throughout the service. There are some large spaces between units that could be used to position dressing tables, desks, workbenches, dolls houses, tailors dummys and tables with assorted items. Consideration should be given to more wall hangings using fabrics, spectacles, washing lines and handles. A film star gallery has already been started on one wing and this should be developed with some interactive items. Care Homes for Older People Page 18 of 26 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. The people who live there benefit from a well trained staff team. Evidence: Comments from people who live there included they are doing a decent job, these girls, look at them, they are lovely, lovely soft skin and they work very hard here. Our SOFI observation showed good levels of interaction with individuals. Some staff engage with people very well and have clearly built very positive relationships with individuals. Other staff we saw are still too task orientated and may need more help in looking at what being person centred really means. A more advanced area that could be developed is around the interaction skills of staff. The team should look at how they positively engage with each person who lives there and develop communication charts to help with this. Staff need look at developing communication that increases peoples wellbeing and avoid questions or demands that may detract from it. A good programme of training is available to staff. staff need to think about the importance of mealtimes as a social occasion and think about their practice when supporting people. The home has got strong links with the Local Authority and staff are able to access these courses along with those provided by the organisation. We Care Homes for Older People Page 19 of 26 Evidence: saw that this training has included courses about Safeguarding, medication, First Aid, falls prevention along with basic and advanced dementia skills. Reminiscence training has been commissioned by the home from the Alzheimers Society and this is due to take place shortly. The AQAA stated that we ensure that all staff, Volunteers and service providers such as the hairdresser, are CRB and POVA checked before they commence employment. We saw records of the Criminal Record Bureau (CRB) checks that have been carried out by the service. Care Homes for Older People Page 20 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well. the culture of the home values people with dementia and helps them lead fulfilling lives. Evidence: The manager has been in post since February 2008 and is in the process of being registered with the Care Quality Commission. The service has developed well under her guidance and the people living there clearly benefit from her leadership and ethos. The manager has also fostered strong links with the Local Authority and has been involved in giving good practice presentations at local conferences. The manager has management qualifications and we have again recommended strongly that she looks at further specialist training around dementia care. This will continue the development of the service. Annual surveys are carried out by the organisation and quality assurance managers visit the home regularly to carry out audits. The home was awaiting feedback from the Care Homes for Older People Page 21 of 26 Evidence: latest survey at the time of this inspection. Meetings for the people who live there are held monthly and we saw minutes of these that included discussion around menus and activities. We have recommended that the home looks at using observation more within its quality assurance procedures. Tools such as dementia care mapping can provide valuable insights into the quality of care provided. More informal peer observation could be used to look at specific areas such as mealtimes. Health and Safety is managed well. we saw that regular checks take place around important areas such as Fire Safety and hot water temperatures. Care Homes for Older People Page 22 of 26 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 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 We recommend that the home keeps developing the assessment format to be person centred and focused on ensuring individual wellbeing. The home should continue to develop the care plan format in use. The focus should be on presenting user friendly information that focuses on wellbeing and good quality of life. Care staff need to be able to get the information they need easily to provide support in the way the individual likes it. Respite care plans could be developed and further improved. Staff should think about the importance of mealtimes as a social occasion and reflect on their practice when supporting people. The practice of staff eating with the people who live there should be extended with all the staff working within the service involved. 2 7 3 4 7 15 5 15 Menus should be produced in picture formats. There may be opportunities to help people make more instant choices Page 24 of 26 Care Homes for Older People 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 about what they want to eat. The use of bibs should be reviewed. 6 19 The manager and staff should continue to develop the environment to provide many more items for people to use and engage with. Space between units could be used for larger items such as desks, workbenches and dressing tables. Interactive wall hangings could also be used throughout the home. Some care staff need to move away from task orientated care practices. Additional training and mentoring may help to do this. More advanced training around dementia care skills could be considered for some staff. Handovers could be used to focus in on communication with individuals and share good practice. 9 10 31 33 The manager should access further specialist training around dementia care. The home should use more observational tools to develop the quality of service. 7 30 8 30 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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