Care Home: Abbotsbury

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What the care home does well The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and well maintained. The Statement of Purpose and the Service User Guide were revised in May 2007, giving up to date information about the home and the services provided to prospective and current residents. The pre admission assessments were in sufficient detail to decide if the home could meet the person`s needs or not. Assessment of needs continued following admission in order to devise an effective care plan so that staff know what care they should be providing to meet the needs of the people living at the home.A resident was identified as having a pressure sore following hospital admission. Care plans included instructions in relation to the care needed because of this sore, ensuring that the appropriate care would be provided. Health records contained evidence confirming that where extra care is required it is correctly monitored and recorded. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in care files. All residents observed or spoken with during the visit were well groomed and looked well cared for. Examination of the storage, administration and handling of medication showed that residents health and welfare were safeguarded as medication was held and managed safely and securely and administered by suitably trained staff. All staff responsible for medication had undertaken appropriate medication training. Conversations between staff and residents were respectful and observations of staff practices found that staff responded promptly and sensitively to the needs of residents. Whilst there was no group activity organised by the residential part of the home the day care unit has on-going activity on a daily basis, which residents are informed about and are encouraged to join in. Notices on all units reminded residents of future events and some residents said that they chose to attend these events. In order to meet the cultural needs of current residents, religious visits were arranged to the home at fortnightly intervals. There was information displayed showing involvement with the local church. Residents spoken with said that their visitors were made welcome and that there were no restrictions to them visiting. Residents are offered a varied choice of nutritious meals. Those spoken to about their lunch said, "It was very nice"; " The food is always very good." One resident who had initially come to the home for assessment of their needs and had become a permanent resident that day said, "I previously never wanted to come to a home but it is lovely here. I know I`ve made the right decision." Complaints records provided sufficient evidence to show that complaints were responded to in a timely and objective manner, showing residents and visitors that their concerns are listened to and acted upon. Relatives spoken with also said that they would have no problems talking to the manager about any concerns and said they felt that they would be listened to.AbbotsburyDS0000041957.V347107.R01.S.docVersion 5.2Page 7A visiting district nurse said that she thought Abbotsbury was a very good home; that the staff always fulfilled instructions given -and could be trusted to contact the GP appropriately. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. To further enable residents choice the home holds monthly residents` meetings, where they are consulted about their day-to-day lives at the home, and for which minutes were available. Visitors spoken with made such positive comments as, "the management and staff are tremendous."; "they keep my brother and I informed all the time."; "we are always made welcome and offered tea when we visit." All recruitment practices safeguarded residents from the employment of unsuitable people. The importance of training is recognised. The home had exceeded the target to meet the required number of 50% of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification before the end of the year with the majority of care staff having achieved this qualification. The clerical assistant has also achieved an NVQ Level 2 qualification relevant to the role. A person with the appropriate qualifications and experience for the role manages the home. She had also undertaken training throughout the year to update and further improve her knowledge and skills. Staff and residents spoken with said that the manager was approachable, that they felt supported by her and that they were able to talk to her if they had any concerns. Visitors spoken with also spoke highly of her and her management of the home. The home had a structured quality assurance programme provided by the Local authority. The registered manager routinely undertakes audits of systems and practices carried out in the home. The home therefore can show that it is monitoring the service in order to enable growth and improvement. Effective and accurate records and practices safeguard the residents` financial interests. The home is on target for staff supervision to be given to all staff six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues.AbbotsburyDS0000041957.V347107.R01.S.docVersion 5.2Page 8A random check was carried out on maintenance, servicing and health and safety checks, which included in-house fire safety checks. These were in good order and as staff had undertaken mandatory health and safety related training, indicated that the home was a safe place for people to live and work. What has improved since the last inspection? Care plans are in more detail and now give sufficient information for care staff to be able to provide the care required to meet the needs of the people living at the home. Requirements regarding night checks are included in the care plans and agreed with the resident and/or their representative. A record is maintained of all activities that residents take part in. Residents are cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. A representative of the registered provider makes unannounced visits to the home each month in order to monitor the services provided and sends a report on the visit to us and a copy to the manager. Risk assessments related to falls and pressure sores have been added to the care file for all residents thereby minimising these risks for people living at the home by developing appropriate action/care plans as required. What the care home could do better: Care plans need to be in an easier to read format to make sure that staff are able to extract the information they need to provide the appropriate support to each person. The first floor corridor is in need of redecoration as some wallpaper is peeling and there are stains, particularly above wall lights, that are unsightly. This detracts from the comfort for residents. There should be audits carried out before and after medicine rounds to ensure that staff are administering and recording medication correctly. The manager should monitor that there are sufficient ancillary staff available in the home during the waking day to prevent the need for care staff to take time away from addressing care needs of residents to carry out domestic and catering tasks. CARE HOMES FOR OLDER PEOPLE Abbotsbury Abbotsbury H.E.P. Pettiver Crescent Hillmorton Rugby Warwickshire CV21 4JD Lead Inspector Lesley Beadsworth Unannounced Inspection 24th January 2008 11:10 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 Abbotsbury DS0000041957.V347107.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. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsbury Address Abbotsbury H.E.P. Pettiver Crescent Hillmorton Rugby Warwickshire CV21 4JD 01788 565700 01788 551580 wandacicholaz@warwickshire.gov.uk 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) Warwickshire County Council, Social Services Department Mrs Wanda Cicholaz Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one person aged under 65 who requires personal care and whose needs can be met by the home. 12th October 2006 Date of last inspection Brief Description of the Service: Abbotsbury is a Local Authority home for older people. It provides permanent care, short stays, day care and four beds for use by older people on an intermediate care programme. The home is situated on a housing estate in the Rugby district of Hillmorton. There are local shops close by, and car parking spaces are available in front of the home. Abbotsbury provides accommodation on two floors, in four units, each of which has its own communal areas. Day care provision, which is not currently subject to inspection, is sited on the ground floor, together with the kitchen, laundry, staff offices and the hairdressing salon. On each floor, there are bathrooms and toilets suitable for people with physical disabilities. As well as the staircase, there is a passenger lift to the first floor. All the bedrooms have an en-suite lavatory and wash hand basin. The home is staffed over twenty-four hours. It has a management team comprising of a manager, assistant manager and four care officers. There is also a part time administrator. There are care assistants providing day and night time care. The home employs two cooks, a kitchen assistant, three domestics, a laundry assistant and a helper part funded by the ’Sure Trust’ who helps to support employment for people with a learning disability. The day-care facility was staffed separately and not included in the number of staff employed to meet the needs of residents. Abbotsbury does not provide nursing care. Residents who require nursing attention receive this from the community nurse, as they would in their own homes. At the time of the inspection visit the fees charged by the local authority are in the range from £27.93 for respite care to £387.00 per week for permanent care, depending on the person’s financial situation. The fees do not include newspapers, toiletries, hairdressing, chiropody and trips to. Abbotsbury DS0000041957.V347107.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 2 star. This means the people who use this service experience good quality outcomes. The inspection included a visit to Abbotsbury. As part of the inspection process the registered manager of the home completed an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11.10am and 10pm. What the service does well: The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and well maintained. The Statement of Purpose and the Service User Guide were revised in May 2007, giving up to date information about the home and the services provided to prospective and current residents. The pre admission assessments were in sufficient detail to decide if the home could meet the person’s needs or not. Assessment of needs continued following admission in order to devise an effective care plan so that staff know what care they should be providing to meet the needs of the people living at the home. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 6 A resident was identified as having a pressure sore following hospital admission. Care plans included instructions in relation to the care needed because of this sore, ensuring that the appropriate care would be provided. Health records contained evidence confirming that where extra care is required it is correctly monitored and recorded. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in care files. All residents observed or spoken with during the visit were well groomed and looked well cared for. Examination of the storage, administration and handling of medication showed that residents health and welfare were safeguarded as medication was held and managed safely and securely and administered by suitably trained staff. All staff responsible for medication had undertaken appropriate medication training. Conversations between staff and residents were respectful and observations of staff practices found that staff responded promptly and sensitively to the needs of residents. Whilst there was no group activity organised by the residential part of the home the day care unit has on-going activity on a daily basis, which residents are informed about and are encouraged to join in. Notices on all units reminded residents of future events and some residents said that they chose to attend these events. In order to meet the cultural needs of current residents, religious visits were arranged to the home at fortnightly intervals. There was information displayed showing involvement with the local church. Residents spoken with said that their visitors were made welcome and that there were no restrictions to them visiting. Residents are offered a varied choice of nutritious meals. Those spoken to about their lunch said, “It was very nice”; “ The food is always very good.” One resident who had initially come to the home for assessment of their needs and had become a permanent resident that day said, “I previously never wanted to come to a home but it is lovely here. I know I’ve made the right decision.” Complaints records provided sufficient evidence to show that complaints were responded to in a timely and objective manner, showing residents and visitors that their concerns are listened to and acted upon. Relatives spoken with also said that they would have no problems talking to the manager about any concerns and said they felt that they would be listened to. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 7 A visiting district nurse said that she thought Abbotsbury was a very good home; that the staff always fulfilled instructions given -and could be trusted to contact the GP appropriately. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. To further enable residents choice the home holds monthly residents’ meetings, where they are consulted about their day-to-day lives at the home, and for which minutes were available. Visitors spoken with made such positive comments as, “the management and staff are tremendous.”; “they keep my brother and I informed all the time.”; “we are always made welcome and offered tea when we visit.” All recruitment practices safeguarded residents from the employment of unsuitable people. The importance of training is recognised. The home had exceeded the target to meet the required number of 50 of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification before the end of the year with the majority of care staff having achieved this qualification. The clerical assistant has also achieved an NVQ Level 2 qualification relevant to the role. A person with the appropriate qualifications and experience for the role manages the home. She had also undertaken training throughout the year to update and further improve her knowledge and skills. Staff and residents spoken with said that the manager was approachable, that they felt supported by her and that they were able to talk to her if they had any concerns. Visitors spoken with also spoke highly of her and her management of the home. The home had a structured quality assurance programme provided by the Local authority. The registered manager routinely undertakes audits of systems and practices carried out in the home. The home therefore can show that it is monitoring the service in order to enable growth and improvement. Effective and accurate records and practices safeguard the residents’ financial interests. The home is on target for staff supervision to be given to all staff six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 8 A random check was carried out on maintenance, servicing and health and safety checks, which included in-house fire safety checks. These were in good order and as staff had undertaken mandatory health and safety related training, indicated that the home was a safe place for people to live and work. What has improved since the last inspection? What they could do better: Care plans need to be in an easier to read format to make sure that staff are able to extract the information they need to provide the appropriate support to each person. The first floor corridor is in need of redecoration as some wallpaper is peeling and there are stains, particularly above wall lights, that are unsightly. This detracts from the comfort for residents. There should be audits carried out before and after medicine rounds to ensure that staff are administering and recording medication correctly. The manager should monitor that there are sufficient ancillary staff available in the home during the waking day to prevent the need for care staff to take time away from addressing care needs of residents to carry out domestic and catering tasks. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 9 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. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 10 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 Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 11 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): 1,3,6 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home a Service User Guide and a Statement of Purpose that had been updated in May 2007 and that were provided to prospective residents. There was a copy of both in each bedroom viewed. They provided sufficient information to help someone to make a decision about whether to move into Abbotsbury or not. Three care files were examined as part of the case tracking process. Preadmission assessments were in place, kept in a separate folder from the care files. The assessments were carried out using a format provided by the Local Authority and that included all the necessary headings. The assessments were in sufficient detail to decide if the home could meet the person’s needs or not. Each person case tracked had assessments and care plans completed by the Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 12 care manager/social worker. Assessment continued following admission in order to devise an effective care plan so that staff know what care they should be providing to meet the needs of the people living at the home. The home caters for four short stay residents who are admitted to the home for assessment purposes in order to ascertain how and where their needs could be best met. As also referred to in the Annual Quality Assurance Assessment (AQAA) each resident has an ‘Additional Information’ booklet that is completed by the resident and/or their family and friends to add to the assessment process. The home provides intermediate care for up to four people in a designated area of the home. The manager advised that care staff are guided by occupational therapists and physiotherapists to support these people to be able to return home. These specialists are therefore very involved in the devising of their care plans. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 13 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): 7,8,9,10 Quality in this outcome area is good. Care plans and risk assessments provide the information required to provide appropriate care for the people staying at the home, although there are shortfalls in the ease of access to this information. Residents have access to health care professionals and are cared for in a respectful manner. Medication systems safeguard the health and welfare of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. All three care files include care plans that had been devised from the home’s assessments and those provided by the care manager. They covered all the areas of need identified in those assessments including personal care, mobility, dietary needs and skin care. There were risk assessments for mobility, falls, pressure sores and moving and handling and Risk assessments were also in place for individual risks such as the use of the call bell or the use of a specific walking frame. If a high risk was indicated in any of these areas a plan of Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 14 action to minimise the risks had been developed in order to safeguard the person or persons to whom they related. The care plans set out the care required in sufficient and up to date detail to ensure that all aspects of the health and personal care needs of residents were met. These plans included an agreement to the need and frequency of checks made on the resident by night staff. Changes in circumstances were recorded on review sheets at a minimum of monthly intervals but in a different section of the file. This information was not transferred to the care plan, as the format did not lend itself to be added to without the whole plan being rewritten. The plans were cumbersome and difficult to extract information from, needing staff to cross-reference between care plan instructions, monthly reviews, appendices and risk assessments. One resident had a pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) that had developed in hospital. Care plans included instructions in relation to the care needed because of this sore in order that appropriate care was given. Preventative measures such as pressure relieving mattresses and cushions were in use for this and other residents at risk of developing pressure sores. Health records contained evidence confirming that when extra care was required it was correctly monitored and recorded, for example, fluid and food intake and body weight had been monitored and recorded for a resident with a poor appetite to make sure that they had sufficient nutrition and that they did not become dehydrated. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in care files. Information related to these visits was recorded in the ‘key events’ section but these were not always entered on the daily records. One daily record showed that a person had complained of earache but not that a GP had been called, diagnosed an ear infection and prescribed antibiotics. Although it was recorded in the key event section this had not been dated and relied on staff looking for and finding this entry. This created the risk that the care staff could overlook it. All residents observed or spoken with during the visit were well groomed and looked well cared for. However one person recently admitted for intermediate care had insisted on not wearing shoes or socks because of tender and blistered feet. None of the sore areas appeared to be infected but apart from the risk of injury or infection to that person there was a risk to other people living at the home. The manager acted promptly to remedy this with the help of the physiotherapists. All those spoken with said that they were well looked after by the staff at the home. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 15 Medication was provided by the pharmacist in multi-dose blister packs, which means that each dose is stored in a ‘bubble’ and dispensed from this. The packs are stored in secure locations on each unit. Controlled drugs were stored in a locked cupboard within a locked cupboard. Examination of the storage, administration and handling of medication showed that residents health and welfare were safeguarded as medication was held and managed safely and securely and administered by suitably trained staff. All staff have undertaken an accredited training course from Boots the Chemist with the majority having also undertaken a Distance Learning Programme in medication which is more in depth and assessed and accredited by an independent contractor. Medication Administration Record Sheets were looked at and were completed satisfactorily. The pharmacist had revised these but staff were having difficulty using them as the print was now very small, and they were concerned that this could lead to errors being made. The codes had also changed which staff said that they found confusing. Tablet count audits were carried out but in order to ensure that staff are competent drug audits should be carried out before and after medicine rounds are undertaken to check that all staff are administering and recording medicines accurately and as the doctor instructed. This would further safeguard the health and welfare of the people staying at the home. Time was spent in the communal areas with residents and staff. Residents were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. Conversations between staff and residents were respectful and observations of staff practices found that staff responded promptly and sensitively to the needs of residents. Terms of preferred address were on the residents care plan and heard to be used by staff. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. Residents were offered varied and stimulating occupation. Visitors were made welcome and their needs considered. Residents had choices and control, over their daily lives. Residents enjoyed the nutritious and varied meals provided in pleasant surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ “leisure, social and lifestyle” needs were included in the care plans where hobbies, interests, religious needs and cultural needs were recorded. The manager said in the AQAA that, “every effort is made to enable continuity (of these interests and needs) in the home and to develop new interests.” Whilst there was no group activity organised by the residential part of the home the day care unit has on-going activity on a daily basis, which residents are informed about and are encouraged to join in. Notices on all units reminded residents of future events and some residents said that they chose to attend these events. Photographs were available to show how special occasions had been celebrated. Care staff were seen to be spending time with residents and on one unit the member of staff was doing a crossword with one resident whilst sharing interesting articles with other residents sitting close by. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 17 In the same lounge the member of staff asked residents if they would like to watch television or listen to music. Residents chose to listen to Joseph Locke and time was spent in between songs discussing the singer. All activities experienced by residents were recorded on a daily social/activity sheet. The AQAA and notices displayed in the reception showed that the home had a Relatives Association that carried out fund raising events in order to finance activities for people staying at the home. Religious visits were arranged to the home at fortnightly intervals. There was information displayed showing involvement with the local church. Residents spoken with said that their visitors were made welcome and that there were no restrictions to them visiting. However the manager states in the AQAA that “should a resident not wish to see a particular person this would be recorded on their file”. Visitors spoken with made such positive comments as, “staff are tremendous.”; “staff keep my brother and I informed all the time.”; “ we are always made welcome and offered tea when we visit.” Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. One resident who had initially come to the home for assessment and had become a permanent resident that day said that previously, “I never wanted to come to a home but it is lovely here. I know I’ve made the right decision.” Small pieces of furniture, pictures, ornaments and photos belonging to the occupants were seen in bedrooms showing that residents were able to bring personal possessions with them when they came to live in the home. To further enable residents’ choice the home holds monthly residents’ meetings, where they are consulted about their day-to-day lives at the home, and for which minutes were available. The home has a dining area on each of the four units, all of which were pleasant and cosy places to take meals. Some residents chose to take their meals in their bedrooms. The menu offered a nutritious and varied choice, which for lunch on the day of the visit was beef stew and dumplings or Cornish pasties with carrots and/or other mixed vegetables and potatoes, followed by semolina pudding or apple pie. This was well presented and residents spoken with said that they had enjoyed their meal with comments such as, “It was very nice” and “I think the food here is very good.” Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 18 There was a choice of drinks offered at mealtimes and beverages were provided throughout the day. Age appropriate drinking vessels were provided with residents being asked whether they wanted a cup or a mug for hot drinks and drinking glasses were available for cold drinks. This maintained their dignity and self-esteem. Care staff were available to assist with the meal and any support required was given sensitively and discreetly. In order to assist staff in meeting the nutritional needs of the people living at the home the catering staff and some of the care staff had attended training related to nutrition, and in food hygiene. The kitchen was visited briefly and found to be clean and in good order. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 19 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): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was readily available to residents and visitors with leaflets being obtainable in the reception and the policy being included in the Service User Guide. There was also an easy to see suggestion box in the reception for compliments, comments and complaints. Complaints records showed that there was one on-going investigation regarding the action taken following a fall and a further complaint, that was upheld, regarding the removal of medication from a bedroom for safety purposes but without the consent of the owner. The records provided ample evidence that complaints were responded to in a timely and objective manner, showing residents and visitors that their concerns were listened to and acted upon. Relatives and residents spoken with also said that they would have no problems talking to the manager and staff about any concerns and they felt that they would be listened to. There had been no complaints referred directly to us. According to training records viewed, the majority of the staff had undertaken training related to the protection of vulnerable adults thereby giving them the knowledge to be able to identify abuse and to protect people at the home from abuse. This subject is also included in the induction training of new staff. Discussion took place with staff regarding protection of vulnerable adults and Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 20 they were able to show that they were aware of what abuse was and what to do if they suspected abuse had taken place. The home had the Local Authority’s Vulnerable Adults policy. There had been no Protection of Vulnerable Adults referrals made about the home. All recruitment practices safeguarded residents from the employment of unsuitable people. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 21 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): 19,20,24,25,26 Quality in this outcome area is good. The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and well maintained. Infection control is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The reception area was welcoming with a small sitting area for residents’ use. A divan bed stored under the stairs detracted from this but the manager advised that this had been donated and that they were waiting for the maintenance person to move it. The home is divided into four units, two on the ground floor and two on the first floor. There is also a day care service but this is not a registered service and therefore was not included in this inspection. Each unit has its own living and dining areas. The communal accommodation was comfortable and attractively furnished and carpeted, with coordinating and mainly attractive Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 22 décor. The first floor corridor was in need of redecoration as some wallpaper was peeling and there were unsightly stains, particularly above some wall lights. This detracted from the appearance and comfort for residents. Lighting was domestic in appearance and all areas viewed were of sufficient brightness for residents to be able to see clearly. All radiators were guarded to prevent anyone suffering accidental burns. Temperature controlled valves were fitted to all resident accessible hot water outlets that were viewed. It was confirmed by the manager in the AQAA document that this applies to all areas occupied by the residents, to maintain hot water at temperatures at around 43°C in order to prevent any accidental scalding. These temperatures were checked regularly and remained within required limits. Televisions in the lounges visited were large enough for residents to be able to view easily. Toilets, bathrooms, communal areas and bedrooms were clearly labelled to assist people living at the home, particularly those with dementia. All bedrooms had ensuite facilities of a toilet and wash hand basin but those looked at had insufficient storage space for toiletries. Residents were encouraged to personalise their rooms and some had brought small items of furniture into the home with them. All the rooms looked at had such personal items as photographs, pictures, ornaments and plants. The residents spoken to said they were happy with their accommodation and that they were comfortable in the home. All communal areas where staff and residents were expected to wash their hands had soap dispensers and disposable towels provided in order to prevent cross infection. Further evidence of infection control practice was seen in the appropriate provision and use of protective clothing. All areas of the home visited were free of any offensive odour. Laundry facilities were inspected and found to be well organised, clean and hygienic. The appropriate laundry equipment was provided. Residents’ clothing seen appeared to be well cared for. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of the residents but the lack of ancillary staff at weekends and evenings may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas showed that there were five care staff in the home in the morning and afternoon and between four and five in the evening, one on each unit and a fifth working where needed. There were two care staff during the night between 10pm and 7.15am. The day care staff starting times were staggered between 7am and 8am. The home uses their own ‘bank/relief’ staff to cover absences amongst the staff group but have also needed to use agency staff recently. To maintain continuity for the people living at the home they have managed to negotiate with the agency that the same people are used wherever possible. A clerical assistant supports the manager, assistant manager and care officers. In addition there are domestic and catering staff as follows. Staff member Sunday Monday Tuesday Wednesday Thursday Friday Saturday Cook 1 Abbotsbury 8.30- 8.30- 8.30Version 5.2 8.30Page 24 DS0000041957.V347107.R01.S.doc 3.30 Cook 2 Kitchen Assistant Kitchen Assistant Laundress Domestic Assistant Domestic Assistant Domestic Assistant 3.30 10.3012.30 8.30-3 10.3012.30 3.30 10.3012.30 8.30-3 10.3012.30 3.30 8.30-3 10.3012.30 10.3012.30 9.30-3 8.3010.30 & 1-3 9-1 9-1 9.302.30 9-10.30 & 1-3 10.3012.30 9.302.30 9 -10.30 & 1-3 9.302.30 9-10.30 & 1-3 9-12.30 9-12.30 9.302.30 9-10.30 & 1-3 9-12.30 9-12.30 9-12.30 9-12.30 9-12.30 9-12.30 As there are no catering staff after 3.30pm on any day and no domestic or laundry staff in the evenings or at weekends it is inevitable that management and/or care staff need to be involved in providing the evening meal and in carrying out any necessary domestic tasks in the afternoon, evenings and at weekends, taking them away from the direct care of the people living at the home. This creates the risk of needs not being met during these times. However the home was clean and free of any offensive odour at the time of the visit and residents clothing seemed to be well cared for and there appeared to be sufficient care staff to meet the needs of the people living at the home. The home had exceeded the target to meet the required number of 50 of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification before the end of the year with the majority of care staff having achieved this qualification. The clerical assistant has also achieved an NVQ Level 2 qualification relevant to the role. Three staff files were examined and references and the appropriate Criminal Records Bureau disclosures and Protection of Vulnerable Adults checks were included. Evidence of employment history and interviews were also present. All recruitment practices safeguard residents from the employment of unsuitable people. The manager advised at the time of the visit and in the AQAA that training for all staff was on going. Training records were looked at and confirmed this. Staff files looked at also included evidence of induction and other training undertaken by individual members of staff. Apart from Induction for new staff recent training undertaken by staff included mandatory training such as Moving and Handling, Fire Safety, the use of hoists and First Aid. The majority of staff had also undertaken training related to nutrition and food hygiene, medication, anti-discrimination practice, equality and diversity and infection control. Some staff had also undertaken training in managing dementia and dying, death and bereavement. The training gives staff the knowledge and Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 25 skills to be able to support people living at the home and safeguard their health, safety and welfare. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 26 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): 31,33,35,36,38 Quality in this outcome area is good. A person with the appropriate qualifications and who has previous management experience manages the home. The monitoring and auditing of the service and practices ensures that all services operate in the best interests of residents. Health and safety practice protects residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been at the home for four years and previously had worked for 28 years in a residential setting. She had completed a NVQ level 4 in management, has a social work qualification and is registered with us, the commission, giving her the appropriate qualifications and experience for the role of manager. She had also undertaken training throughout the year to update and further improve her knowledge and skills. She was present Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 27 throughout the inspection and was knowledgeable about the people using the home. Staff and residents spoken with said that she was approachable that they felt supported by her and that they were able to talk to her if they had any concerns. Visitors spoken with also spoke highly of her and her management of the home. An assistant manager and three care officers make up the rest of the management team, supported by a part time clerical assistant. The home had a structured quality assurance programme provided by the Local authority. The registered manager routinely undertakes audits of systems and practices carried out in the home. A representative of the registered provider visits the home unannounced each month and carries out a quality audit inspection and a report of this visit is then sent to us and to the manager of the home. The home therefore can show that it is monitoring the service in order to enable growth and improvement. The manager said that the residents are encouraged to manage their own finances but some money is held on behalf of some of them and is kept in a secure location. This is the responsibility of the senior staff and the clerical assistant. A random selection of transactions, recorded by two people, and cash balances were checked and were found to be in good order with appropriate receipts kept with the records. The management were aware of the process for arranging an independent advocate if a resident or their family were unable r unwilling to manage their finances. The residents’ financial interests are therefore safeguarded. The manager gives staff supervision to the senior staff and they then each give supervision to a designated group of staff. The home is on target for this to be given to all staff six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. A random check was carried out on maintenance, servicing and health and safety checks, which included in-house fire safety checks. These were in good order and staff had undertaken mandatory health and safety related training, indicating that the home was a safe place for people to live and work. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 29 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. 1. Standard OP7 Regulation 15 Requirement All changes in circumstances need to be added to the actual care plan. This will ensure that these needs are met. Timescale for action 15/04/08 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. 3. 4. Refer to Standard OP7 OP7 OP9 OP19 Good Practice Recommendations Information in care plans should be easily accessible to enable care staff to provide the appropriate care. Key events related to a person’s well being should be included in daily records. There should be audits carried out before and after medicine rounds to monitor that staff are administering and recording medication correctly. Monitoring must take place to ensure that there are sufficient staff at all times to meet the needs of the people staying at the home. This will ensure that their needs are met and safeguard their well being. There should be sufficient storage space in ensuite bathrooms. There should be sufficient ancillary staff in the home to DS0000041957.V347107.R01.S.doc Version 5.2 Page 30 5. 6. OP19 OP27 Abbotsbury prevent the need for care staff to be taken away from their time with residents. Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 31 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 Abbotsbury DS0000041957.V347107.R01.S.doc Version 5.2 Page 32 - 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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