Care Home: Abbeywood Care Home

What the care home does well Routines in the home are quite flexible and residents can choose when they get up and go to bed. Meals are well presented with choices given at mealtimes and a variety of home cooked meal and home baked cakes and puddings. Medication is managed well with administration storage and disposal carried out safely and accurately. What the care home could do better: The manager needs to record any staff medication observations so it is clear that the member of staff knows how to administer medication. All staff who administer medication should also attend medication training as soon as possible. More information is needed when staff apply for a position in the home, so that the manager has sufficient knowledge about the person. Prospective staff need to have a full working history and two written references so that staff are aware of their past work experience and can identify any gaps in employment. This makes it less likely that people who should not work with vulnerable residents can gain employment in the home. Staff must have an induction that provides them with information and skills to support residents effectively. There must be records kept of induction and training. A manager in day to day control of the home needs to apply to CQC to become the registered manager. Random inspection report Care homes for older people Name: Address: Abbeywood Care Home Ribble Road Fleetwood Lancashire FY7 7BX two star good service 21/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Pauline Caulfield Date: 0 3 0 2 2 0 1 0 Information about the care home Name of care home: Address: Abbeywood Care Home Ribble Road Fleetwood Lancashire FY7 7BX 01253776761 01253776761 tojo1717@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Dr Shanmugam Subbiah Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 25 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 25 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: Dementia - Code DE The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home This home is registered for twenty five people who have dementia. It is within easy reach of shops, local facilities and the promenade. The home is purpose built on two floors and has a passenger lift for those who need it. The home has eight single bedrooms and ten double rooms. There are no en-suite facilities. There is one large lounge/dining area and a separate room used by people Care Homes for Older People Page 2 of 11 2 1 0 7 2 0 0 9 Brief description of the care home who smoke. Externally there is a small patio area at the rear of the building that is accessible to people who use wheelchairs. The home has a Statement of Purpose and Service User Guide providing information about the care provided, and the service available so that people can make an informed choice about moving into the home. A copy of the Service User Guide and the most recent inspection reports is made available to all users of the service to help them to make an informed choice about whether to move into the home. At the time of this inspection the fees were £375 per week with additional expenses for hairdressing, chiropody and toiletries. Care Homes for Older People Page 3 of 11 What we found: The random inspection was carried out because of several concerns raised about recruitment and selection, medication management and some areas of care and support in the home. These concerns were passed to the owner to investigate and the information returned to us suggested that some regulations may not be being met. There were nine people living at Abbeywood when we carried out our inspection. One person had moved from hospital into the home the day before the inspection. All nursing residents who used to live in the home had been reassessed and had moved out of the home into alternative accommodation. The home is now only providing residential care. We checked how medication was managed. We observed a member of staff administering medication. Medication was being administered safely and satisfactorily. Staff were seen checking medication against the medication record and signing the medication administration record as soon as the resident had taken the medication. Residents were given a drink with their medication to assist with taking the medication. Creams, ointments, eye drops and other similar items were dated on opening, so that staff knew how long they had been in use. This is particularly important for medication that has to be discarded after after a set amount of time. There are records of staff signatures in place of those staff who administer medication. Staff also sign a form to say they have completed the medication administration to make it clear who is responsible for the medication management at that time. Only senior care staff administer medication. We discussed how staff would administer any medication during the night as a senior care staff is not always working at night. There is no regular night time medication needed at present. The manager said they plan to have a senior care on duty every night rather than the current four nights a week. Presently staff would need to contact the manager or other senior staff on call to administer any medication at night. This could cause delay if medication were needed. Medication is being checked into the home by two staff and checked out by two staff using a record giving details about the medication being returned to the pharmacy. Both staff and the pharmacy sign the record to show the medication has been returned. Some staff administering medication have completed formal medication training either while at Abbeywood or in other homes. Three staff have not received formal medication training but medication training had been arranged for all staff administering medication, for the week following the inspection. The manager said that she had also carried out one to one observations with all staff to check they administer medication safely. However a record has not been kept of the observations and should be. Concerns had been expressed over rising and retiring times and food provided in the home. A small number of residents were still in bed from choice at the start of the inspection at 10.30am. The manager who has only been in the home for a few weeks, said that residents are encouraged to choose when to get up and go to bed. This is not Care Homes for Older People Page 4 of 11 yet recorded on care plans but she said that care plans are being developed soon to provide more detailed information. There were rotating menus in place, offering residents two choices each mealtime. If residents do not like these they are offered alternatives. Residents find it difficult to choose which meal they want in advance so both meal options are plated up as the meal starts and residents asked which one they would like, then given their choice. The lunch time meal was hotpot and vegetables or pasty, potato slices and vegetable with sponge and custard for sweet. There was plenty of food for the residents meal. It looked good and residents were eating it with enjoyment. One resident said, It is good. In the kitchen, there were satisfactory stocks of food in place with cupboards and freezers quite full and evidence of frequent home cooking and baking. The cook said she liked to cook everything from scratch rather than rely on pre prepared foods. Staff felt that residents enjoyed the home cooking and frequent home baked goodies. Staff rotas showed sufficient staff on duty doing the inspection to provide good care and support to residents. Concerns had been expressed about staff being recruited without references. The records of five members of staff were checked. All applicants had an application form but this provided limited information. All applicants only had a limited work history. varying from nine years to less than a year and showed only the year of change if any date provided. Most applicants did not have the reason for leaving previous employment and any possible issues had not been explored or written explanations provided. If it appears that an applicant has had issues at a previous employment, information should be sought, and a record kept. The application forms requested little detail and even the little detail requested was not fully completed by applicants. The date the application form was not completed in most cases, the work history scant and referees not recorded in some cases. This is not safe and effective recruitment and puts residents at risk. A complete working history from first to present job exploring and recording any gaps is required so that there are full details of applicants previous jobs, duties and the length of time they remained in these jobs. Two staff files checked had two written references in place on the inspection, but during discussions with the owner before the inspection, he accepted that at least one reference for one member of staff, had not been received before the person started work in the home. Three members of staff had no written references in place. The manager said this was because she had worked with the staff previously and she was going to be one of their referees, but had not yet written the references. She felt that she knew them well, so did not feel it was as important to get references. Regardless of knowing the staff concerned independent references should have been sought. The staff files seen showed that some of the staff had worked in another care home until recently but no reference had been sought from the actual employer or anyone still employed in the home. The manager had worked in the same home until recently but Care Homes for Older People Page 5 of 11 should still have sought a reference from the employer. If writing references for staff she worked with previously she needs to make it clear that she is no longer employed as the manager of the home she previously worked in. The three staff had no other references. This is not acceptable and seriously reduces the effectiveness of the recruitment procedure. Two written references including one from the previous employer must be received before any member of staff commences employment. There was health information in place for some staff and all staff had Independent safeguarding authority (ISA) checks before starting work at the home and were awaiting Criminal records Bureau (CRB) checks. These are checks that look at whether staff have been convicted of a crime or have been reported as unsuitable to work with vulnerable people. There was appropriate identification in place for all staff. There was evidence that one member of the staff checked had received a basic induction so that they had some awareness of the care and support they needed to provide and how they should do this. However this was a very brief checklist and was unlikely to meet the member of staffs induction needs. There was no evidence to show any of the other staff, including the manager had received an appropriate induction. The manager said she and the staff had received induction but this had not been recorded. All staff should receive a comprehensive induction with records kept, when starting to work in a home. Some of the care staff checked have completed National vocational qualifications (NVQ) in previous employment. NVQs are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. There was information about previous qualifications and courses attended in previous employment for two members of staff. Others had no information about qualifications, skills and experience. This is unsafe recruitment and selection and as such puts residents at risk of being supported by people unsuitable to work with vulnerable adults. We had advised the owner prior to the inspection of concerns CQC had received about the recruitment and selection in the home. He had assured us that recruitment was carried out safely and correctly. This is clearly not the case. Recruitment and selection must be improved as a matter of urgency. The registered manager of the home resigned in October 2009 as the owner had applied for a variation to change the home from a nursing home to a care home. The application to vary conditions was to reduce resident numbers from 28 to 25 people with dementia, to change the name from Ribble Lodge to Abbeywood and to remove the nursing category and become care home only. CQC agreed to reduce numbers and change the name of the home on the certificate but refused the request to remove nursing care from the certificate of registration at the time. This was because suitable arrangements for people who required ongoing nursing care, had not been made and one or more nursing residents was still living in the home. All nursing residents have since moved from the home. The new manager was appointed in January 2010. She had been in post three weeks at Care Homes for Older People Page 6 of 11 this inspection. She said she will apply to become the registered manager of the home within the next few weeks. The recruitment and selection issues in the home could have changed the homes quality rating had this random inspection been a key inspection. The inspection schedule for Abbeywood may change as a result of this inspection. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, 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 29 19 Prospective staff need to have a full working history and two written references before commencing employment so that the employer is aware of their past work experience and can identify any gaps in employment. 09/03/2010 2 30 18 Staff must have an induction 09/03/2010 with records kept, that provides them with information and skills to support residents effectively. 3 31 8 The owner needs to put forward a manager to apply to become the registered manager of the home. so that there is someone responsible for the day to day running of the home. 23/04/2010 Care Homes for Older People Page 9 of 11 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 9 All staff who administer medication should receive medication training so they know what medications are used for and how to administer, store and dispose of medication safely. The manager should record any staff medication observations so it is clear that the member of staff knows how to administer medication. Forms used for prospective staff applications should be updated to include all relevant information about the individuals educational and employment history, so that the employer has enough information about them. 2 9 3 29 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. 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