Care Home: Abbots House

CARE HOMES FOR OLDER PEOPLE Abbots House 103 Abbots Road Abbey Hulton Stoke on Trent Staffordshire ST2 8DJ Lead Inspector Amanda Hennessy Key Unannounced Inspection 25th February 2009 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbots House Address 103 Abbots Road Abbey Hulton Stoke on Trent Staffordshire ST2 8DJ 01782 234888 01782 232938 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stoke on Trent City Council Miss Amanda Jane Lowndes Miss Melanie Joy Fenton Care Home 39 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (39), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (6), Physical disability over 65 years of age (39) Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 Dementia (DE) - Minimum age 55 years on admission Date of last inspection 5th March 2007 Brief Description of the Service: Abbots House is a Local Authority Stoke-on-Trent Social Services home that provides care for up to 39 older people who have dementia, a physical disability, or other mental health problems that are neither dementia nor learning disability. There are an additional three places which provide shortterm care. Located in Abbey Hulton, the home is a two-storey property providing all single bedrooms. There are four separate living areas, each having a lounge-dining room with adjacent bedrooms, bathroom and toilets. First floor accommodation is generally accessed by the passenger lift. For emergencies and for service use, there are enclosed staircases at either end of the building. Externally there is a car park and the rear garden offer an enclosed area for people to use. The location of this home ensures that there is a wide range of community facilities nearby that can be readily accessed. As no information is included in this report about fees the reader is advised to contact the service direct for this information. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. The means the people who use this service experience excellent quality outcomes. One Inspector carried this unannounced inspection out over one day. The home had fifteen people living there at the time of the inspection. Time spent visiting the service was six and a half hours. As it was unannounced neither the service nor the provider knew we were going. The home’s Deputy manager was present throughout the inspection. Information for the report was gathered from a number of sources: a questionnaire- Annual Quality Assurance Assessment (AQAA) was completed by the homes manager and sent to us; we looked at the premises, records and documents. We had discussions with the Deputy manager and care staff, people who live at the home and their relatives to gain their views on what it is like to live in and receive care at the home. We looked at how the service has responded to any concerns, how it protects people from abuse and how staff have been recruited and trained. We also looked at the number of staff available to care for people at the home. Three people who live in the home were ‘case tracked’ this process involves establishing people’s experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes of the care that they receive. Tracking peoples’ care helps us understand the experience of people who use the service. What the service does well: The manager told us that: The service provides a high standard of care to all people living at the home by a team of motivated staff with the appropriate experience and skills to meet the needs of people who live at Abbots House. Our findings from our inspection support this we found that: Peoples’ needs are assessed before they come to live at the home. Assessment of peoples’ needs, gives confidence that staff are aware of their needs are and will be able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. People receive good standards of care and support which meets their individual needs and choices. Healthcare needs are met by the home. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 6 People told us that the food is; “good and there is always a choice available”. Activities take place most days and trips outside the home are also arranged. The Home has an experienced Manager who provides appropriate and effective leadership. The manager and staff act on any concerns that are made, giving confidence that people are listened to and feel safe living at the home. Knowledgeable and friendly staff provide care to people using the service. Staff, are committed to caring for the people. Staff told us: I love working here. What has improved since the last inspection? What they could do better: We have not made any requirements as a result of this inspection. We did advise staff should check the prescription before it is sent to the pharmacy to check that the prescription accurately details peoples medicines and that two staff confirm the accuracy of handwritten entries for medicines to minimise the risk of medication errors. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 and 6. Quality in this outcome area is good. People have their needs assessed and are provided with the required information to enable them to make the decision that the home is suitable to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people who come to live at Abbots House have an assessment of their needs before agreement is made that the home would be suitable for them. People are encouraged to visit the home before they choose to come to live there. Staff told us that people have the opportunity to visit before they move into the home. A visitor told us: We visited several homes but this was the one we were most impressed by. And I cant fault it here everyone is so friendly. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 10 The home specialises in the care of people with dementia. We found that the changes to the environment of the home facilitate peoples memory and orientation to the building and staff knowledge and training in dementia supports this. The home does not provide intermediate care. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. People who use the service can be confident that their health and personal care will be based on their individual needs and their rights of privacy and their dignity will be respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that following an assessment of peoples needs a plan of care is developed. Care records seen gave good instructions for staff about peoples strengths and needs and how they should be met. We found that care plans were person centred; this means that they reflected their individual needs, capabilities and choices. Care plans are reviewed monthly by staff ticking that their needs have changed but is was sometimes difficult to see what these changes had been such as difficulties in mobility or problems eating and drinking. We advised that staff write about the changes to ensure that any changes are clearly identified. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 12 Care records also identified people choices and preference such as for male or female staff to provide their personal care and the time they preferred to get up and go to bed. The service has records to show how they monitor peoples health for example; their weight, risk of pressures sores and difficulties eating and drinking. People living at the home have access to a wide variety of healthcare professionals according to their needs. It is also positive that as part of the current major refurbishment there will be provision within the centre for medical assessment unit for people with elderly mental care needs and the home will also benefit from this close working relationship. Visitors told us: The staff always tell us when my relative is unwell, needs to see a doctor, has had a fall or needs to go to hospital they are very good. The storage and administration of medicines at the home is undertaken by trained care staff and is done both safely and appropriately. We did advise staff that further (but minor) improvements could be made to reduce the risk of potential errors. For example; we advised that staff should check the prescription before it is sent to the pharmacy to check that the prescription accurately details peoples medicines and that two staff should confirm the accuracy of handwritten entries for medicines. We observed staff interact in a friendly and respectful way using people’s choice of name. When we asked relatives if they felt that staff respect their loved ones, they told us: “Oh yes always”. The home has ensured that there is information about the person’s choices for the end of their life and arrangements after their death to ensure that their last wishes can be met. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. People have the opportunity to make choices about their life at the home and maintain relationships with friends and relatives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ interests and choices are recorded within their care records. A life history is completed and details all the stages of their life with key events and people identified, this gives staff a good insight to peoples’ life and their preferences. We observed that people are able to get up and go to bed when they wanted to and spend their day how and where they choose. The home has activities organised on a daily basis by care staff. Activities include: sing-a-longs, movement to music, pamper sessions, games, quizzes and a reminiscence sessions. During our visit it was lovely to see staff chatting with people who live in the home discussing photographs and memory cards of past times which was enjoyed by all. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 14 The mobile library also visits the home monthly enabling people to borrow books of their choice. The library also loans the home a reminiscence box, this month it was in sickness and health with DVDs, videos, photographs and other items such as ration cards, medical cards and a first aid box. The purpose of reminiscence is to provide a talking point and stimulate peoples memory to try to slow down memory loss experienced by people with dementia Visitors are able to visit the home at any reasonable time in the day. The home offers people using the service the opportunity to take communion on a monthly basis if they wish to. The Home has a five-week rolling menu. There are at least two meal choices available at each mealtime, although staff did say that if people do not like either choice an alternate is offered. In addition the home also has a ‘finger food’ option to promote the independence and dignity of people who may find it difficult or lack concentration to sit and eat a meal. Staff are able to have a meal alongside people living at the home they told us: “The food is excellent here and there is always a choice available.” Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. People are listened to and can feel assured that the home will act in their best interests and protect them from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is included in the Service User Guide and is also displayed in the home. The home has had no complaints in the last year. The Deputy Manager told us; “there are appropriate systems in place should any complaints be made and all concerns would be recorded to and responded to as the complaints policy”. The Commission for Social Care Inspection has also received no complaints about the home. Visitors told us that they know how to make a complaint: “I would tell the staff.” The manager made has made appropriate referrals when there have been aggressive incidents between people living in the home. The manager ensures that all required actions were undertaken to keep people safe. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 16 Staff we spoke to said that they would highlight any concerns to whoever is in charge of the shift or the manager. It is positive that all staff have had adult protection training and had an awareness of what constitutes abuse. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. The environment is homely, well maintained, clean and a safe place for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Abbots House provides an accessible and safe environment that meets the needs of people with dementia. The home has been completely refurbished with changes designed specifically to meet the needs of people dementia based around best practice guidance from Stirling University. The home consists of three separate units each with its own lounge/ dining and kitchen area although people living at the home can move freely throughout the entire home. Each unit can accommodate up to ten people. All bedrooms Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 18 are single and although do not have ensuite facilities bathrooms and toilets are located close to peoples bedrooms. Toilets doors are yellow to enable people to remember which is the toilet and help to aid their continence. Each bedroom door is lockable and at the side of each bedroom door there is a memory box with items of interest to the person that help the occupant find their room. The service has enclosed and safe gardens where people living at the home are able to wander as they choose. A recent addition to the garden has been the sensory garden with water feature. Staff told us: Its lovely when its dark as it all lights up and when the water feature is on it looks lovely. There is a separate main kitchen and laundry that we did not look at. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is excellent. The home has knowledgeable staff who understand and meet peoples needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is staffed with excellent staffing levels and skill mix to meet people’s needs. Staff told us that they are taking full advantage of there not being as many people living at the home by spending more time with those currently living at the home. It was lovely to see staff chatting and sharing their experiences of life with people living at the home. Staff we met spoke positively about support and training they receive and were knowledgeable about peoples’ needs. Staff told us that: I love working here. Its feels like a family working here, and Ive worked her for a long time and all the changes that weve had have all been for the better. I love the environment and the time that we have for residents now. The home has eighty- eight percent of its care staff with a care qualification (minimum of National Vocational Qualification level 2. This gives confidence that staff are knowledgeable, understand peoples’ care needs and that people are in safe hands. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 20 We did not look at staff recruitment during this inspection, as the home has had no new staff. Staff have transferred to the home from other council homes that have recently closed and therefore are not considered to be new staff. We found at the previous inspection that the homes recruitment meets standards of good practice that protect people who live at the home. We were told that if and when the home has new staff, staff will have, induction training that meets the “Skills for Care” standards. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is excellent. The home has effective leadership that ensures that the service is run in the best interests of those who use. Appropriate health and safety practices are in place to help keep people safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager has managed Abbots House for three years but has had a total of eighteen years experience managing care homes. The manager has expressed a desire to make Abbots House a ‘centre of excellence’ for care of people with dementia and is currently undertaking further qualifications in dementia care. We found that the manager is on track to achieve her ambition with improvements in the environment, staff training opportunities alongside the Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 22 enthusiasm of the staff to develop the care for people with dementia. The manager holds frequent staff meetings and maintains a record to ensure that staff are kept updated and informed of information given during the meetings. Staff we spoke to said that they felt that the manager and the management team are all approachable and provides them with assistance and support they need. The home has a quality assurance programme. We were told that surveys are sent to all peoples relatives and all interested parties, which are later, analysed to see if there are any areas that the home can improve upon. It is positive that staff do audits of areas of practice such as the environment, medication and care records. Audits identify areas of good practice and also when improvements are required and when appropriate actions are identified for the development plan for the home. The homes Annual Quality Assurance assessment (AQAA) was sent to us when we asked and gave us a good account of the services provided and identified areas for future development. The home does not act as appointee for people using the service. There are appropriate arrangements in place when people request it to keep small amounts of money for services such as hairdressing and toiletries. There is a record of all transactions and receipts are available to confirm the transactions. We recommended that there is a regular audit of peoples money. Staff told us that they receive supervision but not always at the recommended frequency. Records of supervision that showed us that it cover all aspects of practice. The home has an up to date health and safety policy for safe working practice with a range of risk assessments. Staff receive training and regular updates in all mandatory training. Maintenance contracts were randomly selected and were found to be up to date. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 3 x 3 Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations Staff check the prescription before it is sent to the pharmacy. Two members of staff confirm the accuracy of hand written medication records. Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Abbots House DS0000028862.V374302.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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