Care Home: Abbots Grange Residential Home

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What the care home does well One service user told us that they received enough information to help them decide if Abbots Grange was the right place for them before they moved in and that they had been given written information about the homes terms and conditions. Care plans are reviewed and updated monthly to reflect any changes in a service users condition or to highlight changes in care needs Each service user had their own individual file that contained their personal information and their care plan. The majority of the care plans were well written,person centred and offered guidance to staff on what or how to meet the service users needs and wishes in their day to day lives. We asked service users what the home does well one service user told us, "as much as they can under the circumstances". A service user told us that they, "always" get the medical care they need" The home has a visiting hairdresser who visits the home once a week. Service users spoken to said they were able to receive visitors at any time. One service user said that they had someone to speak to informally if they were not happy and knew how to make a formal complaint if they needed to.Five staff told us they knew what to do if someone has concerns about the home. Abbots Grange is situated in a residential area away from the noise of busy roads and traffic.There are garden areas and off road parking is available. What has improved since the last inspection? We reported on the last inspection that the homes statement of purpose and service user guide should be rewritten to clarify the types of people and the age range which the home can provide care for and how those peoples needs will be met. We were told by the area manager that this had now been done.This is so that people are provided with information that supports people who use services or others acting on their behalf, to understand the care, treatment and support provided. Since we last visited we were told that the home has focused on strengthening the care plans and have developed a new format to reflect more individualised,person centred care. We were told since we last inspected that the home have improved on the decoration of some rooms and have purchased new dining room furniture. We were told that in the last 12 months following concerns about the security of the home, new security lights around the grounds have been installed,window locks have been fitted and night staff have a telephone number of someone from head office who they can call at any time through the night if there was any concerns about security.On the inspection we were told that senior managers had advertised extensively to find the right manager for Abbots Grange and that the successful candidate commences employment on 19th April 2010. What the care home could do better: There are requirements and recommendations which are identified on this inspection which must be addressed by the home. Key inspection report Care homes for older people Name: Address: Abbots Grange Residential Home Newport Street Werneth Oldham OL8 1RE     The quality rating for this care home is:   one star adequate 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: Kath Oldham     Date: 1 3 0 4 2 0 1 0 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 40 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Abbots Grange Residential Home Newport Street Werneth Oldham OL8 1RE 01616243752 F/P01616243752 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Westholme Care Home Limited Name of registered manager (if applicable) Mrs Carolyn Litherland Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home is registered for a maximum of 40 service users to include: *up to 15 service users in the category of DE(E) (Dementia over 65 years of age). *up to 30 service users in the category of OP (Old age, not falling within any other category). *up to 10 service users in the category of PD(E) (Physical disability over 65 years of age). Date of last inspection Brief description of the care home Abbots Grange Residential Home provides 24-hour personal care and accommodation for up to 40 service users over the age of 65 years. Abbots Grange Residential Home is owned by Westholme Care Home Limited. Care Homes for Older People Page 4 of 40 Over 65 15 30 10 0 0 0 0 7 0 7 2 0 0 9 Brief description of the care home The home is situated on a quiet residential street in Werneth, approximately one mile from Oldham town centre. Local shops and a doctors surgery are about a ten minute walk away. Buses are available to Oldham and Manchester from Manchester Road, which is a ten-minute walk away. A small drive leads to the home, which was once a large Victorian house. To the side of the property is a small garden area. A car park is available to the front of the home. The home has been extended to the rear to provide accommodation for up to 40 service users. Bedroom accommodation is provided on both the ground and first floors. The home also has a mezzanine level but access to these bedrooms is restrictive, due to steps. There are 32 single and four shared bedrooms. En-suite toilets are provided in all the bedrooms, except five rooms. There are two lounges and one dining room on the ground floor. The home has one assisted bath, one unassisted bath and one shower room. The current weekly fees we were told is £375. Further details regarding fees are available from the manager. Care Homes for Older People Page 5 of 40 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: one star adequate 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 visit was unannounced, which means that the owner/manager, staff and service users were not told that we would be visiting, and took place on 13th April 2010 commencing at 11.30am. The area manager and senior management were available on the visit and provided us with information and records,in addition to the support from staff on duty during our visit and service users. The inspection of Abbots Grange included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection which was held in July 2009. Every year the owner,person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some weeks before our visit a senior manager from the company was asked to fill in a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do. Care Homes for Older People Page 6 of 40 We considered the responses and information the senior manager from the company provided and have referred to this in the report. Abbots Grange care home was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at Abbots Grange the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at Abbots Grange talking with the area manager, senior managers and staff.A tour of Abbots Grange was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Abbots Grange was meeting the needs of service users and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of service users. The care service provided to three service users was looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track service users care to see whether the service meets their individual needs. The term preferred by people consulted during the visit was service users. This term is, therefore, used throughout the report when referring to people living at Abbots Grange. A brief explanation of the inspection process was provided to senior staff at the beginning of the visit and time was spent with the owner on conclusion of the visit to provide verbal feedback. We have not received any complaints about this service and we have been notified of one safeguarding matter which is being investigated by outside agencies at this time. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? We reported on the last inspection that the homes statement of purpose and service user guide should be rewritten to clarify the types of people and the age range which the home can provide care for and how those peoples needs will be met. We were told by the area manager that this had now been done.This is so that people are provided with information that supports people who use services or others acting on their behalf, to understand the care, treatment and support provided. Since we last visited we were told that the home has focused on strengthening the care plans and have developed a new format to reflect more individualised,person centred care. We were told since we last inspected that the home have improved on the decoration of some rooms and have purchased new dining room furniture. We were told that in the last 12 months following concerns about the security of the home, new security lights around the grounds have been installed,window locks have been fitted and night staff have a telephone number of someone from head office who they can call at any time through the night if there was any concerns about security. Care Homes for Older People Page 8 of 40 On the inspection we were told that senior managers had advertised extensively to find the right manager for Abbots Grange and that the successful candidate commences employment on 19th April 2010. 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 9 of 40 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 10 of 40 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 moving into the home are given information about the home and have their needs assessed so they will know if their needs can be met at Abbots Grange. Evidence: We were told in the AQAA, Prospective service users are welcomed prior to admission to visit the home and stay for lunch or a cup of tea or coffee with family members. At this time they will receive a tour of the home and a brochure with basic information. A Statement of Purpose and a Service User Guide are available for inspection within the home and a copy of the Service User Guide is available on request prior to admission. We can offer the facility for an overnight stay, or day care, prior to admission to support people in making a more informed decision. One service user told us that they received enough information to help them decide if Abbots Grange was the right place for them before they moved in and that they had been given written information about the homes terms and conditions. Care Homes for Older People Page 11 of 40 Evidence: We reported on the last inspection that the homes statement of purpose and service user guide should be rewritten to clarify the types of people and the age range which the home can provide care for and how those peoples needs will be met. We were told by the area manager that this had now been done.This is so that people are provided with information that supports people who use services or others acting on their behalf, to understand the care, treatment and support provided. There is some information in these documents which needs updating to reflect the changes in management and the change in the name and address of the Commission.This will ensure people have accurate information. We looked at a selection of service users care files. There was evidence of an assessment having taken place by a senior manager in the ones we looked at. Abbots Grange does not provide intermediate care. Care Homes for Older People Page 12 of 40 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. Service users health and personal care needs were being met by staff that respected their privacy and dignity. Evidence: Since we last visited we were told that the home has focused on strengthening the care plans and have developed a new format to reflect more individualised,person centred care.The detail we were provided in the AQAA told us, Our service users all have an individualised care plan which provides in depth knowledge of their abilities, the care they require and their personal needs and choices. Care plans are reviewed and updated monthly to reflect any changes in a service users condition or to highlight changes in care needs. Service users and their families are encouraged to have involvement in every aspect of their care. Each service user had their own individual file that contained their personal information and their care plan. The majority of the care plans were well Care Homes for Older People Page 13 of 40 Evidence: written,person centred and offered guidance to staff on what or how to meet the service users needs and wishes in their day to day lives.However,the plans need to detail all aspects of service users life and include social, recreational,religion and finances. Risk assessments formed part of the care planning process and the format for these assessments was easy to understand.Several care plans contained risk assessments relating to individuals including moving and handling,the risk of falls and nutrition. Daily records formed part of service users care plans.The majority of records were informative. Care plans demonstrated the name of service users GP and records demonstrated that visits were made to service users from GPs,district nurses and other health professionals.Service users spoken to said their health care needs were met and the staff would contact a GP if they needed a visit. When we looked around the home we identified a notice on a service users bedroom door which drew attention to the fact that they were unwell. The senior accompanying us on the tour identified that this detail shouldnt be on display and removed the notice stating that this detail should be within the service users care plan and communicated to staff in a different way. The placing of such detail on as service users bedroom door does not promote their privacy and self worth. Service users spoken to said that staff treated them with respect and their privacy was maintained. Service users have access to a General Practitioner,Chiropody and Dental services and all NHS facilities available, where possible service users are encouraged and supported to choose their preferred services and also to attend appointments with outside agencies in order to maintain their optimum health and well being. We asked service users what the home does well one service user told us, as much as they can under the circumstances. Five staff told us that there are alwaysenough staff on duty to meet the individual needs of all the people who use the service.These staff also told us they felt they had enough support, experience and knowledge to meet the differing needs of people who live at the home. Medication administered was recorded on medication administration records(MAR).The MAR sheets sampled were generally all accurately signed by staff to show that people Care Homes for Older People Page 14 of 40 Evidence: had received the right medication. Records were maintained of staff signatures,photos of people to show who has what medication and information about the medication that people took. Some service users had been prescribed medication by their doctor after the medication records had been printed by the chemist. These details were handwritten on the medication administration records. When additional medication is handwritten on these records best practice is that they are signed by the staff member making the entry then signed by a second staff member to verify that the entry has been copied accurately. This ensures that service users get the medication they are prescribed at the right frequency and dosage and this routine is an additional safeguard for service users and staff.This needs to be arranged. When service users dont want there medication or it is not needed a symbol is used. In this instance O. This symbol needs to be defined each time it is used to detail why the medication hasnt been given as prescribed. This will enable an accurate record to be maintained and will provide the right explanation why the service users hasnt had the medication which staff will be able to refer to when needed. This again needs to be arranged. A service user told us that they, always get the medical care they need Care Homes for Older People Page 15 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of social and recreational activities may result in service users needs not being met. Evidence: We were provided with information in the AQAA completed before we visited that told us, Abbots Grange has a warm and friendly environment where routines are flexible and resident based.We do not have restricted visiting times to encourage relatives to visit at their convenience.To encourage relatives to visit for longer some relatives may eat with their family member which we feel mirrors a normal day to day situation that would occur in their own home. The home has a visiting hairdresser who visits the home once a week.The designated hairdressing salon gives residents a more pleasant experience. Many of the service users,we were told in the AQAA are able to go out with relatives and friends which staff encourage,whilst carefully documenting and handing over to other shifts the service users whereabouts and who they are with to ensure a safe return.One service user goes out to a computer club weekly with the assistance of the ring and ride service.One service user told us that the home arrange activities that Care Homes for Older People Page 16 of 40 Evidence: they can take part in if they want to. In the last twelve months we were told that home has improved by the introduction of a new activities programme, which includes age specific activities and residents are now offered an alternative choice of meal at mealtimes. We looked at the record of activities which were recorded as having taken place. There were entries such as DVD afternoons, armchair exercises, cards and dominoes, bingo,arts and crafts and listening to music. There wasnt however anything recorded as having taken place since February 2010. We commented earlier in this report that not all service users care files detailed the activities they liked to take part in or if they had any cultural or religious needs. So it wasnt possible to evidence that activities were routinely provided to those service users who are not able to arrange these for themselves. One service user did tell us that the home didnt provide anything in the way of activities and if you didnt arrange your own occupation or stimulation then there wasnt anything to do during the day at Abbots Grange. During our visit there were no organised activities, stimulation or occupation for service users. Service users who have some level of confusion were seen to interact with themselves and staff did engage with them to provide some stimulation or distraction from what they were doing. Staff dont appear to have time to provide stimulation to service users. There was no evidence that service users had regular access to social and recreational activities to meet their interests and needs. Service users spoken to said they were able to receive visitors at any time. Service users who were able to tell us confirmed that they were able to choose what time they went to bed,what time they got up and what they wished to wear. The majority of the service users we asked said that they enjoyed the food served at the home and that they were given a choice. One service user said that the food was monotonousand the temperature of the food was not to their liking at times.We were also told in a comment card completed by one service user that the meals are always good. We looked at the menus which we were told were a three week menu. When we looked at the record of food served to service users the meals were repeated more regularly than the menu indicated. Most weeks we looked at detailed the menu to be cottage pie, corn beef hash, mince and onion,a roast dinner and fish. The variety recorded as being provided to service users does not give them a change in menu and Care Homes for Older People Page 17 of 40 Evidence: the repetition of certain meals does not provide variety or the nutrition that should and could be provided to older and vulnerable people. There were no menus displayed to inform service users or visitors what the meal of the day is. This would promote some service users independence as they could refer to the menu or be reminded what the meals are for the day. Staff do ask service users what they would like each day and this is recorded as it should be. We didnt see any evidence that the menu cycle had been reviewed and updated in the past six months or if service users opinions had been taken in to account when formulating the menu. We were told that service users or family meetings do not currently take place. This does need to be arranged to enable service users to be involved in what is going on in the home and influence any developments and decisions. Pureed food should not be pureed all together and served in a bowl. To ensure pureed foods are presentable and appealing each pureed food should be served separately, ideally using a scoop, piping bag or a mould. Pureed foods should be fortified with milk, cream or milk powder as opposed to just water,stock or gravy. This will enhance service users enjoyment of the meal and enable staff to let the service users know what they are eating. The cook works up to 2.00pm each day. The tea time meal dependent on what it is is prepared in part by the cook before they go of duty. Care staff prepare or finish off the tea time meal which takes them away from caring and supporting service users. On the visit some service users were having bacon and mushrooms for tea which has to be prepared from scratch by care staff.In addition care staff have to wash and dry the crockery and pans from these meals as the dishwasher isnt in working order. Time taken to undertake these roles detracts from the support care staff are able to give to service users. Staff did tell us that they ensure that only one care staff is in the kitchen while the other is available to service users. There are only two care staff on duty throughout the day and night. We looked at a selection of records kept in the kitchen to ensure procedures are followed to keep service users safe and well in relation to food safety. A format used called safer food better business provides the opportunity for catering staff to record everything as it should be. This record had not been completed since 21st March 2010. This doesnt promote safe food handling. Care Homes for Older People Page 18 of 40 Evidence: Service users religious observance is not currently provided for at the home. There are no visiting clergy. Staff said there is a church down the road that service users could go to if they wanted. We were also told that one service users is taken by their relative to the Salvation Army. The management need to be more in tune with service users religious preferences and look at providing these to them either in the home or in the community. We were told that one service user who used to go to computer classes now goes to arts and crafts class and creative writing at a centre nearby. This is usually with support by the service users family and or ring and ride services. We asked to see the last environmental inspection report. The report we were provided with was dated July 2008. That inspection made recommendations that included some which didnt appear to have been addressed by the owner. Or if they had been they needed to be addressed again. These included repainting of the floor in the dry food room as the flooring was worn and to replace some missing wall tiles. The owner said he was under the impression that these had been addressed. To ensure compliance with food safety regulations these need to be actioned. Care Homes for Older People Page 19 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and their relatives are able to complain and they know who to contact if they want to make a complaint. Evidence: The home told us that they have, a thorough complaints procedure which all our service users and families are aware of.This procedure is on display in the hallway and can also be found in the service users guide and statement of purpose.We also have an Adult Protection, Abuse and whistle blowing policy that all staff are aware of. One service user said that they had someone to speak to informally if they were not happy and knew how to make a formal complaint if they needed to.Five staff told us they knew what to do if someone has concerns about the home. The home had a complaints procedure and copies of the document were accessible within the home and formed part of the Statement of Purpose. Service users spoken to said they felt comfortable in talking to the staff if they had a concern or a complaint. It is the procedure of the home to record all complaints, complaint investigations and outcomes. No complaints had been recorded as having been received since 2008. The complaints procedure could be used as a development tool to improve on service Care Homes for Older People Page 20 of 40 Evidence: provision and to check that when service users make comments about the care, support and attention they receive that,these comments are recorded and also the record indicates what has happened to put things right or change things. The complaints record would be an ideal tool to demonstrate that the home listens to the comments made and acts on these. A recommendation to further develop the recording of the comments or complaints received is made in this report. A policy was available for the Protection of Vulnerable Adults and a copy of Oldham Social Services Safeguarding procedures was accessible to staff working at the home. The training records we were shown on our visit didnt detail which staff had received protection of vulnerable adults training. We asked that the home provide to us the names of staff and the dates they had received this training. We were told that two staff had received protection of vulnerable adults training on 19th April 2010 and senior managers were unable to locate any other records in regards to this training. A new manager commenced work on the 19th April 2010 and we were told by senior management that they had handed over the training requirements,which the manager is arranging immediately. One referral had been made to Oldham Social Services Safeguarding Adults unit since the previous inspection took place. This investigation is currently ongoing. Some staff have some awareness of the Mental Capacity Act through training and the implication this has in relation to risk taking and peoples choice.It is recommended that any restrictions of peoples personal choices be agreed in line with the principals and guidance in the Mental Capacity Act.Evidence should be maintained of the decision making process and peoples involvement in this and where possible written agreement of the restriction is made with the person involved. It wasnt indicated on the training record which we were provided with on the inspection which, if any staff had received Mental Capacity Act (DOLS)training. We asked to be given the names of staff and the dates they received this training. We received information which told us that, Staff carried out Mental Capacity Act training during the month of November 2010. We were not informed if all staff had received this training as they need to. Arrangements need to be made for all staff to attend this training so they have an Care Homes for Older People Page 21 of 40 Evidence: understanding of the implications of the Act and how this will affect the service users in their care. We asked to see the record of residents meetings. We were provided with some notes on a meeting which was held in July 2008. We asked service users about meeting with other service users and staff to share their views and opinions about the service provided at Abbots Grange. We were told that residents meetings do not take place. It is important that residents have an opportunity to meet together to discuss their views and opinions and developments in the home. Care Homes for Older People Page 22 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are not enabled to live in a pleasant, safe and hygienic home due to the lack of maintenance of the environment. Evidence: We were told since we last inspected that the home have improved on the decoration of some rooms and have purchased new dining room furniture. The home feel they do well at, Abbots Grange is situated in a residential area away from the noise of busy roads and traffic.We have pleasant garden areas and sufficient parking. The interior character of the home has been maintained as much as possible and the entrance area to the home is very welcoming. We provide a warm, comfortable and clean environment. We have large communal areas and a designated smoking room for those residents who wish to smoke. Our communal areas are decorated to provide a homely feel. Our main communal area is very large and the adequate seating has been positioned carefully to partition the room and create separate seating areas which make the most of our pleasant exterior views. As the residents spend a lot of time in the communal area we feel that the layout does not feel institutionalized or clinical in any way. We were told that in the last 12 months following concerns about the security of the home, new security lights around the grounds have been installed,window locks have Care Homes for Older People Page 23 of 40 Evidence: been fitted and night staff have a telephone number of someone from head office who they can call at any time through the night if there was any concerns about security. We had a look around the communal areas of the home, at some bathrooms and toilets and in eight service users bedrooms. The home looks tired and is in need of repainting and the replacement of carpets and furnishings throughout the home and in service users bedrooms. The home had an odour of urinary incontinence in the dining room and in some bedrooms. This isnt good enough. With good personal care routines and good and regular cleaning of the house there is no reason why there should be a smell of urinary incontinence.The respect of service users is not promoted by the home through the lack of attention to detail within their surroundings. The carpet in the lounge was heavily stained and was in places dirty. We were told by the owner that they had a good quality carpet cleaner and that the carpet had been replaced about two years previously.This is not disputed however the appearance and stains on the carpet doesnt promote the respect of service users. We saw one of the service users bedrooms which had been wallpapered and had a new carpet laid and we saw and were told of the plans decorate other service users bedrooms. The lounge did not feel homely or personalised. The lounge is a large area and further thought needs to be given to the layout possibly of furniture, especially while numbers are low about how the home can enhance the appearance of the room. Redecoration would help. Pictures and mirrors were on the wall. The mirrors on the lounge walls were at a height that people wouldnt be able to see into them. There is a smaller lounge off the main lounge which is used by service users who choose to smoke. There are currently no procedures in place to safeguard staffs health who may need to go into this lounge to provide support or assistance to these service users. This needs to be in place and management need to refer to recent smoke free regulations and initiate some protection for staff. The toilets on the ground floor were not welcoming. Tiles were missing from the walls and the design of the toilets with partitions separating them doesnt enhance their appearance. The toilet seat in one of the en suites was heavily worn and was in need of replacement. In one service users bedroom the bedroom window was cracked and needed removing and in two service users bedrooms we had a look at the double glazed windows were misted so service users wouldnt be able to see out of the Care Homes for Older People Page 24 of 40 Evidence: windows with ease. The curtains in some of service users bedrooms we looked in needed to be rehung. They appeared not to have enough curtain hooks on them and did not enhance the appearance of the room. Doors through the home were wedged open. These doors are fire doors and in the event of a fire could compromise the health and safety of service users, staff and visitors. If doors are to be opened to make it easier for service users to get about independently then alternative arrangements need to be made to safeguard service users, staff and visitors. At least two bedroom doors we tried did not close sufficiently into the rebate to act as a barrier in the event of fire. One bedroom door closing mechanism was missing so there was a hole in it. This again reduces the function of the door as in an emergency situation the door would not act as a barrier as it is intended. The lack of the closing and locking mechanism does not promote the service users right to privacy. Care Homes for Older People Page 25 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a team of staff who know them well, but as staff have not had up to dates or mandatory training some of the methods used for helping service users may not be as safe as they should be. Evidence: We were told that in the next twelve months the home plans to, have 100 of staff trained to at least NVQ level 2 and 25 of those staff will have achieved level 3,this will enable them to deliver high quality,knowledge based care to our service users. We were also told that,We have a thorough recruitment procedure and ensure that a full employment history is completed on staff application forms.All staff have POVA checks and detailed references are sought prior to employment.We have a stable,experienced staff team with a good skill mix who have been working in the home for many years.Our low staff turnover creates a stable environment for our residents. We asked service users what the home could do better, one service user told us, more carers.We were told by one service user that staff are,usually available when they need them and they usually receive the care and support they need and staff usuallylisten to them and act on what they say. Care Homes for Older People Page 26 of 40 Evidence: Five staff told us they felt they had enough support, experience and knowledge to meet the differing needs of people who live at the home. We looked at one staff file for someone who had been appointed since we last visited Abbots Grange in July 2009. We saw that all the references were received before the person started. We couldnt see on file the criminal record bureau disclosure and asked to be informed when this was received. At the time of writing this report we hadnt received this information as we had requested. It is therefore not possible to state that staff are recruited to roles at Abbots Grange properly to keep service users safe. We were told that the new staff member had been given the induction training (skills for care) standards when they started work at the beginning of December 2009. We couldnt see and no one could tell us how the new staff member had progressed with the induction or what support or mentoring they may have received to assist them to understand and complete the essential induction training. We were told this would be checked out right away.This practice doesnt not give us confidence that staff are being supported to do there jobs well. We looked at the record of essential staff training. Staff training needs to be in place to make sure staff do their job properly and safely not putting themselves or service users at risk. We identified that some staff were recorded as having had training or updates in moving and handling training for example. Seven staff were not indicated on the training record as having had this training. We asked to be provided with the dates these staff did this training, We were told five of these staff had done this training on 9th February 2010. This means that two staff have not undertaken this training, one of which is a new staff member working on nights. The lack of training could compromise the health and safety of service users and staff and needs to be arranged. The training record didnt identify staff having undertaken food hygiene training. We asked one member of staff who said they had undertaken this training a couple of years ago. The cooking staff finish working at 2.00pm each day. Care staff prepare or finish of tea and prepare suppers and should have received food hygiene training to make sure they know the regulations in relation to food hygiene and safe practice in relation to the preparation and serving of food. Cooking staff must also have this training and or updates to this training as governed by Food Hygiene regulations and standards.We have asked to be informed of the names of staff and the dates they had this training. At the time of writing this report this detail had not been provided. Care Homes for Older People Page 27 of 40 Evidence: The home were unable to evidence that staff had received first aid training as is required. The national minimum standards stipulate that staff should have a knowledge of first aid and how to deal with accidents and health emergencies and a qualified first aider should be on duty at all times.This training needs to be arranged to ensure that this is the case. When we looked in a member of staffs personal file,who had been employed at the home for some years we saw a first aid certificate dated 2005. This has now elapsed. Care Homes for Older People Page 28 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems do not ensure the efficient running of the home and the ongoing improvement of the service. Evidence: The home is based on the site of the group head office, with senior management on site the majority of the time. The managers post is currently vacant for which senior management are currently recruiting. We were told, As we are committed to finding the right person we are taking more time than usual over this process and hope to be appointing someone within the next few weeks. When we last inspected in July 2009 we reported that the registered manager was on long term sick and had at that time been off for about 6 months. In June or July 2009 a member of staff was seconded from another home as acting manager. We received a notification from senior management that the acting manager resigned without Care Homes for Older People Page 29 of 40 Evidence: notice on 29th January 2010. Our records dont appear to indicate who was acting manager. On the inspection we were told that senior managers had advertised extensively to find the right manager for Abbots Grange and that the successful candidate commences employment on 19th April 2010. Accidents are recorded in the homes accident book. Completed reports should be removed and stored in accordance with the Data Protection Act. We asked to look at the records of staff meetings. We were provided with some notes from a meeting in September 2008. It is important for staff to have regular meetings with senior managers and also there colleagues to provide them with an opportunity to influence what goes on in the home and to share their views or opinions. A sample of health and safety records was examined for evidence that the homes equipment was being checked regularly.The records we looked at were up to date. When we looked at the most recent passenger lift engineers report from 7th April 2010 they made comments that car light diffuser is damaged should be replaced, buffers are perished and should be replaced, control panel is worn and inaccessible should be relocated to allow safe working. Motor room panel is missing. The lift is in poor condition consideration should be given to refurbishment.When we looked at previous engineers reports from June,August and September 2009 similar comments were made. We looked at a sample of service users monies which are kept by the home for safekeeping so service users can buy toiletries and such like. We were told that some records had been removed from the home and senior management had done their best to make sure that the records in place were accurate. Senior managers are working with the local authority to double check on this. The systems in place to record service users monies need to be improved upon and audited and checked periodically to make sure the records have been completed properly. Advice was given on the inspection of some things that should be changed. The fire records indicated that staff had fire drill training practice in June 2009. To evidence that all staff have undertaken fire drill training best practice is for staff to sign next to there printed name on receipt of this training.To ensure the safety of service users and staff,management need to maintain an accurate and up to date record of all staffs attendance to fire drill training. Care Homes for Older People Page 30 of 40 Evidence: We were told in the AQAA completed by senior management before our visit that in the last twelve months there had been two admissions to Accident and Emergency and one service user had passed away in hospital. Regulation 37 of the Care Home Regulations 2001 indicate that these sorts of occurrences must be notified to the Commission without delay. We have not been notified of these events as we should be.This means that we havent the information we should have about the service provided at Abbots Grange. Staff meet with a senior manager formally when they receive supervision and areas discussed include their work practice and career development needs. Care Homes for Older People Page 31 of 40 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 32 of 40 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 12 13 Record service users 31/05/2010 interests and provide them with on going and regular opportunities for stimulation through occupation,leisure and recreational activities in and outside the home which suit their needs, preferences and capacities. Particular consideration should be given to people with dementia, who have physical disabilities and other cognitive impairments. To provide stimulation and occupation for service users and to occupy them and improve their lifestyle and routine. 2 15 16 Provide choices of food and drink for service users to meet their diverse and individual needs,making sure the food and drink provided is nutritionally 31/05/2010 Care Homes for Older People Page 33 of 40 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 balanced, provides variety and supports service users health. To support the health and welfare of service users. 3 19 23 Undertake an audit of the 31/05/2010 repairs and replacement of furniture, furnishings decoration and carpeting though out the home. Provide CQC with an action plan and identify clear timescales for the repair and replacement and refurbishment of the identified areas in the home. To promote the respect and dignity of service users. 4 25 23 Cease the routine and practice of wedging fire doors open in the home and if these do need to be open undertake risk assessments and look at providing alternatives to the current system of placing wooden wedges in these doors. To protect the health and safety of service users ,staff and visitors. 5 26 16 Eradicate the odour of urinary incontinence throughout the home and introduce appropriate and 31/05/2010 31/05/2010 Care Homes for Older People Page 34 of 40 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 regular routines for cleansing and replacing furniture and fittings throughout the home. To promote the respect and dignity of service users 6 30 18 Undertake an analysis of 30/06/2010 staff training and provide to all staff without delay mandatory training in moving and handling, health and safety, food hygiene and first aid. To keep service users and staff safe and healthy. 7 31 37 Notify the Commission without delay any occurrence as detailed in regulation 37 To comply with the regulations and to ensure the Commission knows about the service 8 31 8 An application must be 19/07/2010 made to the Care Quality Commission for a suitable person to become registered as the manager of Abbots Grange In line with regulations and to ensure a suitable person is employed to manage the home 23/04/2010 Care Homes for Older People Page 35 of 40 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 9 38 23 To maintain the safety of 31/05/2010 service users, staff and visitors provide to the CQC an action plan of proposals to address the comments and recommendations made in the passenger lift engineers report.Provide to the Commission written evidence of any works being undertaken to the lift. To maintain the health, safety and welfare of service users, staff and visitors. 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 Update the statement of purpose and service user guide to reflect the changes in management and the change in the name and address of the Commission.This will ensure people have accurate information. Further develop the care files by including service users likes, needs and preferences in relation to recreation, occupation, cultural or religious needs and finance. Ensure that when a symbol is used in the medication administration records which needs defining that each time it is used it is defined so that an accurate record is made of why medication isnt administered as prescribed. As an additional safeguard for service users and staff ensure that when medication is handwritten in the medication administration records that this is signed by the staff member making the entry then signed by a second staff member verifying that the entry has been copied correctly. 2 7 3 9 Care Homes for Older People Page 36 of 40 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 4 15 Review the arrangements for care staff preparing the teatime meal and washing up after the meal ensuring that the needs of service users are not being compromised from their cooking and preparing meals and washing up crockery after these meals. Repair or replace the dishwasher so staff are supported to do their jobs properly. 5 15 To ensure compliance with food safety regulations the recommendations of the food safety inspector from environmental health in July 2008 which included the repainting of the floor in the dry food room which was worn and the replacement of missing wall tiles in the kitchen must be attended to. Display a menu in an appropriate format for service users and visitors, such as a weekly laminated menu in a suitable print on each table or on a wallboard with the present days menu. This will enable service users to see what the meal of the day is. Review and update the menu consulting with service users and or their representatives on what kind of meals service users would like to have included on the menu. Update the menu to reflect these choices. To ensure pureed foods are presentable and appealing each pureed food should be served separately, ideally using a scoop, piping bag or mould. Pureed foods should be fortified with milk, cream or milk powder unless service users have swallowing problems then commercial food thickener needs to be used. 6 15 7 16 Reschedule regular service user and possibly family meetings to discuss their views, opinions and developments in the home. Record these meetings and make available with any outcomes or action taken to address the discussions at these meetings Further develop the recording in the complaints book to demonstrate that the management listen to what service users or their families, representatives and staff say and detail the action that has been taken and the outcome to the comments or complaints made. 8 16 Care Homes for Older People Page 37 of 40 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 9 18 Provide all staff with training in the mental capacity act and and the deprivation of liberty safeguards. To ensure staff are able to recognise the signs and symptoms of abuse and know what to do if abuse is ever alleged.Provide all staff with protection of vulnerable adults training. 10 19 Replace the smashed or broken windows in the home and repair or replace double glazing units which are misted over. Replace the carpets in the home that are heavily stained and or cleanse them thoroughly to eradicate the stains and smells. Undertake a regular check of all fire doors ensuring that they close sufficiently into the rebate so will act as a barrier in the event of fire. Record these checks and identify any problems identified and the action taken to remedy the fault. Replace the tiling in the downstairs toilets and improve the appearance of these rooms to further promote the comfort and respect of service users. Undertake an audit of all the bathrooms and toilets to ensure that there are locks in place and that these are operational. 11 26 Review the smoke free legislation and put in place policies and procedures for staffs protection in relation to the smoking lounge. Ensure that staff undertake induction training to skills for care specification within there first weeks of employment and systems are in place to check the progress of the staff member providing guidance or support to complete the training.In addition ensure that the work is checked off by someone who is trained, is competent to assess the detail of the induction and has knowledge of what is expected of the induction training standards. Put in place arrangements for staff to have regular staff meetings to enable all staff to meet with their managers in a group and influence the development of the home. 12 30 13 33 Care Homes for Older People Page 38 of 40 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 14 38 To evidence that all staff have undertaken fire drill training best practice indicates that staff sign next to there printed name on receipt of this training.To ensure the safety of residents and staff maintain accurate and up to date records of all staffs attendance to fire drill training. Completed accident reports should be removed and stored in accordance with the Data Protection Act. 15 38 Care Homes for Older People Page 39 of 40 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. 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