Care Home: Abbeyfield House

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What the care home does well The service provided a very pleasant and homely environment. We noted that residents enjoyed a relaxed and friendly environment, that offered flexible routines and supported people to make their own choices, for example, one resident was visited every week by a hairdresser of her choice although others chose to be attended to by the hairdresser arranged by the care home. The quality of the food sampled was very good and planned in consultation with the residents. Residents were able to take part in a range of interesting activities. There were good systems in place to audit the quality of the service; this included checks undertaken by the registered manager and senior managers from the organisation. What has improved since the last inspection? Although the service was previously operative as a registered care home, this inspection has been conducted as a first inspection because the organisation reregistered due to a slight change in its title. However, the service was assessed as being `good` at its previous key inspection, which was conducted in 2007. We have noted that the service has continuously worked on all aspects of its provision, as it is committed to on-going improvement. What the care home could do better: We have issued one requirement within this report, which is in regard to medication practices. Although there were some strengths noted with the management of medication, there is a need to address the issues raised within this report. Other issues have been discussed in this report, such as advice for the improvement of the current care plans, increased dementia care training, monitoring of first aid equipment and safe storage of items that could be hazardous to residents. Key inspection report Care homes for older people Name: Address: Abbeyfield House 6-12 Fairlight Avenue Woodford Green Essex IG8 9JP     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: Sarah Greaves     Date: 2 3 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 24 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 24 Information about the care home Name of care home: Address: Abbeyfield House 6-12 Fairlight Avenue Woodford Green Essex IG8 9JP 02085044188 02085049304 p.boney@abbeyfield.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Society Name of registered manager (if applicable) Pamela Dugdale Boney Type of registration: Number of places registered: care home 18 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 18 The registered person 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 categories, Code OP Date of last inspection Brief description of the care home Fairlight Avenue (6-12) is a registered care home for older people that require general residential care. The service is owned and managed by Abbeyfield Society, which is a national voluntary sector provider of care and housing services for older people. Care Homes for Older People Page 4 of 24 Over 65 18 0 Brief description of the care home The service is registered to accomodate 18 residents. The property is four houses converted into one building. It is situated on a pleasant residential street in Woodford, within a short distance of useful local amenities such as neighbourhood shops, a post office, transport links and pubs. Care Homes for Older People Page 5 of 24 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 key inspection was conducted in one day by one inspector. Although the vast majority of inspections are unannounced, it was necessary to give the service brief notice due to the close proximity to Christmas Day, as residents were due to attend family events, parties and pantomimes. We gathered information through speaking to residents, staff and the registered manager. We toured the premises, and checked the storage and administration of medication. We read a randomly selected sample of the care plans, and looked at relevant policies and procedures including the Service Users Guide, the Statement of Purpose and the Adult Protection procedure, inclusive of whistle-blowing guidance. We checked staff files and had lunch with the residents. The service submitted a well -written Annual Quality Assurance Assessment (AQAA), which is a required audit document. Information from the AQAA was used for this Care Homes for Older People Page 6 of 24 report. Care Homes for Older People Page 7 of 24 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 24 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 24 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. Prospective residents (and their supporters) are assured that their needs will be identified, and they will be supported to have a safe admission to the care home. Evidence: We looked at the care homes Statement of Purpose and Service Users Guide, which were both clearly presented. Residents and their supporters were informed of how to make a complaint within the Service Users Guide and were informed of the role of the Care Quality Commission. At the time of this inspection there were fourteen residents at the care home and four vacancies. We were informed that a significant number of the present residents were admitted independently rather than via a placing authority; therefore the preadmission assessments had been conducted by the registered manager. She stated that relevant parties were asked to contribute wherever possible to this process, for example, information could be sought from General Practitioners and/or district nurses Care Homes for Older People Page 10 of 24 Evidence: (if the prospective resident known to community nursing services). However, the registered manager explained that attempts to get medical and/or health care reports have often been unsuccessful as there is not an obligation for professionals to respond to such requests. A care plan for an individual that was referred by a social worker contained the social work assessment and a doctors letter. The documents used by the service for pre-admission assessments appeared to be of a sufficiently detailed nature and we noted that Abbeyfield updated its forms in accordance to on-going national developments for good practice in the care of older people. Residents were offered opportunities to visit the service prior to moving in. The service appeared to achieve a better ratio of achieving this, particularly as some residents had moved in as part of a carefully planned move from their own home, rather than a move from hospital. The key standard 6 was not applicable for assessment as the service did not offer intermediate care. Care Homes for Older People Page 11 of 24 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. Residents are assured that there are some clearly good practices in place to support their personal and health care needs in a dignified manner; however, some improvements are needed with elements of the medication service. Evidence: We read three care plans during the course of this inspection; these were chosen in order to reflect a variety of care needs. The care plans were relatively new, hence we were not in a position to check how the service conducted periodic evaluations of the identified care objectives. We noted that there was a detailed level of information in an easy to follow format, which would be important in the event of hospital or community health care staff needing to know specific information about a person. Care plans were signed by either the resident, or if necessary, their relative. Discussions with the registered manager confirmed that all of the present residents have a relative or close friend to act as their advocate. We noted some minor issues for improvement. 1) We would advise that the staff do not use abbreviations as this could lead to misinterpretations, such as the use of 2 to indicate a condition secondary to another diagnosis. It would be useful if UTI was written out in full as Care Homes for Older People Page 12 of 24 Evidence: urinary tract infection. 2) There was a misprint on the Waterlow chart template. There was an error on one of the Waterlow charts, which did not give a resident the correct score for their age. On this occasion the error did not impact upon placing this person in the correct risk factor group. 3) Use of the word geriatric within one care plan pointed out to the registered manager, who also found this term not appropriate. Overall, there was good attention to detail, including accurate information regarding weight monitoring, skin care conditions and applicable treatment plans, life histories and a range of relevant risk assessments. Via discussions with the registered manager, we were informed that there were no issues of concern in regard to residents being able to access medical and other health care support. We checked the services storage and administration of medication. It was recommended that the medication guide (British National Formulary) should be updated once every two years, in accordance to good practice guidelines by Care Quality Commission pharmacy inspectors. The copy at the care home was a 2004 edition. Although there were some good practices (such as the careful approach to managing a varying dosage of an anti-coagulant) we observed an unacceptable practice during the lunchtime medication round, which identified a staff training issue. We noted that some residents were keeping specific items in prominent positions within unlocked bedrooms, for example Bonjela, the over-the-counter gel for mouth ulcers. This gel, with a paracetamol content, needs to be kept in a more secure position (such as a drawer or lockable cabinet in the bedroom) or the resident needs to lock their room when it is not occupied. The same practice needs to be applied to topical creams and lotions, which were also prominently displayed in a couple of bedrooms. This practice is necessary to protect any residents with dementia that might wander into another residents room. We observed that there were very good interactions between residents and staff, which produced a relaxed, homely and cheerful environment. The minutes of the residents meetings and the annual reviews evidenced that residents were encouraged and supported to raise any concerns about the conduct of staff. We joined the residents at lunch time and a number of them were keen to inform us that they were very pleased with the approach and friendly style of the staff. Care Homes for Older People Page 13 of 24 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. Residents were provided with suitable opportunities to enjoy social opportunities, including the maintenance of important links within the wider community. The food service was good. Evidence: A significant number of the residents were able to inform us about their daily routine. We noted that people were provided choices and their specific preferences were respected, for example, whether they wished to dine in their rooms or communally, and times for getting up and going to bed. We felt that there was a clear ethos of supporting people to be as independent and as autonomous as they wished to be. The registered manager is undertaking a distance learning course in the Provisions of Activity in a care setting. Care staff have completed a manicure and hand massge course; these courses have been accessed via the national organisation for activities in care homes for older people. Residents informed us of their plans for Christmas, which included making visits to relatives or receiving visits from family and friends. The service promoted a flexible approach to visiting hours, apart from meal times, so that people could concentrate Care Homes for Older People Page 14 of 24 Evidence: upon meeting their nutritional needs. The service had established firm links with the local church and residents were encouraged to invite any other ministers of worship. One of the residents attended a church outside of the area every week; people from his/her church community provided transport. A range of social activities were offered that included the OPERA project (older people in residential accomodation exercise programme for mobility, fitness and falls prevention), pottery, bingo, board games, sherry mornings, hairdressing, monthly visiting guitarist, individual shopping sessions, chatting about current affairs and pampering sessions (manicures by staff and visits from holistic therapists). Residents paid a fee for the hairdressing and holistic treatments such as massage. We observed that some of the residents enjoyed spending time on their own, pursuing their own interests (for example, reading their daily newspaper and/or books, telephoning relatives and friends, and following television programmes of their choice). Residents were able to install a telephone in their room or receive calls on a handset owned by the care home. There was also a payphone on the ground floor. The registered manager informed us that there were new activities planned for 2010, such as the purchase of WI game and the Redbridge Youth Action team will be visiting the residents (for inter-generational communication, including demonstrating information technology skills). We joined the residents for lunch, which was attractively served in the dining area. The food was tasty and balanced, with a couple of choices of vegetables. We looked at the menu plan, which offered residents daily choices. We noted that there were two different fish dishes served on a Friday; the registered manager explained that the menus were planned with the residents at their meetings and all of the current residents enjoyed fish, hence they did not presently want a non-fish lunch option to be placed on the menu. Through speaking to the residents that we dined with regarding the quality of the food, we were told that it was very nice. Care Homes for Older People Page 15 of 24 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. The service listened to the views of the residents and had systems in place to protect the welfare and safety of the residents. Evidence: We read the services complaints procedure, which was made availbale to the residents and their supporters. We noted that the registered manager provided detailed and sensitive responses to the complaints. There was not a large number of complaints; however, we noted that some of the residents at the care home were in a position to either clearly verbally express and/or write their own complaints, which would not necessarily occur at other similar establishments. The service produced a satisfactorily written Adult Protection procedure and staff had received Adult Protection training. We spoke to the registered manager regarding the one safeguarding issue that arose since the last inspection and was now resolved. The registered manager stated that the service had responded by achieving improvements with certain documentation and practices. Care Homes for Older People Page 16 of 24 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. Resident were provided with a pleasant environment. Evidence: The care home is located in a quiet surburban road, with local amenities within the neighbourhood (such as shops, post office, leisure facilities, a library and pubs). The premises comprises of adjoining ordinary domestic properties that has been developed into a care home. We found that the service was comfortable, pleasantly maintained and homely. Residents demonstrated that they had individualised their bedrooms with personal items, and pieces of own furniture if they wished to. There was a choice of communal areas, including a lounge, dining room, conservatory and a rear garden (which had garden furniture, a summerhouse and barbeque facilities for good weather conditions). We noted that the two sheds in the garden were not locked, because repairs were needed on the doors. The service had attempted to make the sheds secure; however, it is advisable that these facilities are kept locked as they were being used for storage of gardening implements and cleaning lotions. The care home was clean and there were no offensive odours. Care Homes for Older People Page 17 of 24 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. Residents are assured that they will be supported by sufficent staff that have been safely recruited and appropriately trained for their roles and responsibilities. Evidence: We noted that there was a sufficient number of staff rostered for the number of residents. The service employed three staff on an early shift, three staff on a late shift and two waking staff on night duty. A senior carer was placed on all of the shifts and the registered manager was ordinarily on duty from 8am to 4pm, Monday to Friday. Over 90 of the care staff had achieved a National Vocational Qualification in Care at Level 2 or equivalent. Staff training records indicated that people undertook mandatory training as required (such as moving and handling, and basic food hygiene) as well as additional training that is relevant to the needs of the residents (dementia care awareness and planned training regarding Deprivation of Liberty, which would be delivered by the London Borough of Redbridge Social Services). Some staff had undertaken Equality and Diversity training, which would be made available to the remainder. We noted that the service was not registered for people with dementia, which was clearly stated within the Statement of Purpose. However, it was acknowledged that a resident might develop dementia after moving in and the service would aim to Care Homes for Older People Page 18 of 24 Evidence: continue to provide care, taking into account that an individual (and their family) chose Fairlight Avenue with the hope that it would be a home for life. Such arrangements would be subject to consultation with all relevant parties, including the resident, their representatives and medical practitioners such as a psychogeriatrician. It was good that staff had attained a half-day training in dementia care; we would hope that this will be built upon, taking into account that training between one and three days is available. There were no issues of concern in regard to the recruitment of staff, as evidenced through checking a random sample of staff records. Care Homes for Older People Page 19 of 24 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 service was well managed in order to best meet the needs and wishes of the residents. A few issues for improvement have been identified in this report; however, we believe that the service has the ability and resources to promptly address these matters. Evidence: The registered manager had been in post for several years, and had the necessary management and care qualifications and extensive experience for her position. We noted that the internal auditing and quality monitoring was very detailed and of a notably good standard. The views of the residents were formally sought through meetings, reviews and questionnaires. We were pleased to find documentation to evidence that the registered manager had spoken to residents following the recent television broadcast of programmes about care homes for older people, to promote their opinions on the service at Fairlight Avenue. Care Homes for Older People Page 20 of 24 Evidence: The service produced suitable health and safety records to demonstrate that appropriate measures were taken, such as professional maintenance of fire equipment, weekly fire alarm tests, periodic fire drills, electrical installations check by a competent person, gas safety certificate and emergency lighting test. The service informed us that the portable electrical appliances testing for 2009 was overdue and had been booked for January 2010. We found that a significant number of the items in the first aid box ( we checked the box kept in the medication room) had expired, although routine checks were regularly occuring. We also observed that a cleaning solution with content hazardous to health had been left in a communal toilet on the ground floor. Care Homes for Older People Page 21 of 24 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 22 of 24 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 9 13 The registered manager must ensure that improvements are implemented regarding the management of medications, including staff training where necessary. To promote the safety of the residents. 28/02/2010 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 Care Homes for Older People Page 23 of 24 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). 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